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COPYRIGHT DEPOSIT. 



TUBERCULOSIS 

And Allied Diseases 



An account of their Origin and 
Treatment from the Earliest Times 
up to and Including the Present 



BY 

FREEMAN HALL, M. D. 

Member of the International Tuberculosis Congress 

The National Association for the Study 

and Prevention of Tuberculosis 

Formerly Acting Assistant 

Surgeon U. S. A. 



THE YONKERMAN COMPANY 

Kalamazoo, Michigan 

U. S. A. 

IQII 






©CI.A303182 




FREEMAN HALL 



PUBLISHER'S NOTICE 



This book, the author's edition of which is distributed free, 
is intended as a privileged communication as from a physi- 
cian to his patient, and it is hoped that it will be respected 
accordingly. 

Although free to all who are in need of its help, it is not 
designed for promiscuous distribution, but will be sent gladly 
on request, v/ithout charge, to any one who, in the reader's 
opinion, would be benefited by its perusal. 



Copyright, ign 

THE YONKERMAN COMPANY 

Kalamazoo, Michigan 

U. S. A. 



DEDICATION 



To the memory of Prof. Robert Koch, whose discovery 
of the tuberculosis germ made it possible to know and 
understand the cause and true nature of the disease tuber- 
culosis: this book, with all deference and esteem, is dedicated. 



VI 



PREFACE 



Anticipating possible criticism of my attitude in this 
work on the Diagnosis and Treatment of Tuberculosis, be- 
cause of having frankly and fully explained to all who read, 
whether layman or physician, the truth as to the lack, of 
certainty and absoluteness of diagnosis in the incipient stage 
of Tuberculosis, except where the tubercle bacillus is actually 
found in the sputum, I think it best to give my reason for 
departing from the usual course of refraining from discussion 
of the diagnostic value of symptoms in a work of this char- 
acter, intended as it is for the eye of both the physician and 
his patient. 

In my experience gained in a long and active practice, the 
last ten years of which have been devoted more particularly 
to the study and treatment of Tuberculosis, I have had much 
opportunity to note the effect of fully and frankly discussing 
with my patients their symptoms; and where these symptoms 
presented doubtful significance in diagnosis, of frankly ex- 
plaining their value. 

It has been my observation that such frank discussion 
leads to a more perfect understanding between patient and 
physician, and where this is the case the treatment prescribed 
is quite certain to have the full and willing co-operation of 
the patient in those minor details which are often the little 
balance required to turn the tide and start the patient toward 
recovery. 



PART I 



HISTORY OF TUBERCULOSIS 

SHALL CONSUMPTIVES BE RESTRAINED BY LAW? 

CATARRH, BRONCHITIS, INFLUENZA, AND THEIR 

RELATIONSHIP TO CONSUMPTION 



TUBERCULOSIS 

*T*HAT there was any lung trouble, Consumption 
or Tuberculosis in those prehistoric days, 
when men lived wild and rugged lives in the mild 
climate of the favored countries where the human 
race first made its habitation, is improbable. The 
disease, in all likelihood, did not make its appear- 
ance until after Man began to live a communal 
life. 

Scholars are agreed that when he wrote the 
treatise, "On Those Who are Attacked by a 
Cough After Illness," Democritus, who to us is 
little more than a name, dim on the borderland 
of legend, was discussing Consumption or Tuber- 
culosis. This work, the title of which alone sur- 
vives, was the first recognition of the disease of 
which we have any record. 

It is unfortunate that the work of this old 
Greek physician has been lost, for it would be 
very interesting to compare his opinion of the 
disease with what is here recorded as the best 
thought of the present time. 



1 2 Tuberculosis 

It is quite likely, however, that he had sound 
views as to the treatment of the disease, for 
what we know of him indicates that he was a 
man of keen discrimination and sound common 
sense. A few hundred years later, in the writings 
of Hippocrates, we find instructions for the man- 
agement of a case which sound strangely modem 
to us. This wonderful Greek, probably a distant 
disciple of Democritus, whose mind seemed to 
grasp the fundamental principles of Medicine 
ages ahead of the knowledge of his time, described 
tuberculosis correctly as a fever and prescribed 
for it, — not prayers and incantations, as had 
been customary among the priests and people 
up to his time, — but fresh air, change of climate 
and hygienic living. 

Galen, the next great name in medical annals 
following that of Hippocrates, endorsed the 
latter's advice. Knowledge of the disease in 
this time (A. D. 131-200) had advanced so far 
that he recognized it as contagious. He con- 
sidered it dangerous for a well person to come in 
personal contact with a consumptive. We now 
know that, to a certain limited extent, he was 



The First Advocate of Curability 13 

correct in this opinion. This is an interesting 
fact, for in later centuries the contagiousness, 
or rather, the infectiousness of consumption was 
lost sight of. Every one, including physicians 
of every nation, looked upon it until recently 
as a strictly hereditary ailment. 

From the time of Aretaeus, Celsus and Fras- 
catorious, to that of Avicenna, who lived A. D. 
980-1037, or about the time William the Con- 
queror invaded England, no progress was made 
in the knowledge of the disease. These men gave 
instructions for its treatment, practically iden- 
tical with those first laid down by Hippocrates. 
The probability is that they were simply copy- 
ists of the great physician who preceded them. 

Not a single person in the world, apparently, 
up to the 17th century, ever entertained the 
thought that the disease was curable. In that 
century a man appeared whose name must be 
ever memorable in the annals of the profession, 
for he, Richard Morton, first declared, in 1689, 
his belief in the curability of the disease. His 
writings give a curious picture of his time, and 
make us thankful that we live under more favor- 



14 Tuberculosis 

able conditions. In his day, consumption, de- 
structive as it is at the present time, must have 
been a scourge, for he says he wondered how 
any one could escape falling a victim to it. In- 
cidentally he praises the vital resistance of 
those who were able to resist the disease, and 
made this capability of some of his contempo- 
raries the text for a homily on the virtues of a 
sober and temperate life. 

The records are again silent as regards the 
disease until the 18th century, when Dr. Syden- 
ham, another colossal medical intellect, the 
greatest, perhaps, since the day of Celsus, wrote 
a long treatise on its treatment, in which he in- 
sisted most emphatically on the importance of 
fresh air. In the 18th century, also, Auenbrugger 
advanced the treatment of the disease in a revolu- 
tionary way by inventing the art of percussion. 

It was not until 1819, however, when Laennec 
published his immortal work, "De 1' auscultation 
Medicale," that the profession really began to 
understand the nature of the disease. Laennec 
studied the anatomy and physiology of consump- 
tion, and formulated certain rules of diagnosis 



What They Thought a Century Ago 15 

which have not been improved upon even to this 
day. Any one afflicted with this disease owes 
a certain debt of gratitude to this great man, 
who devoted many years of his life and all the 
powers of his tremendous intellect to devising 
ways and means for their benefit. 

Boyle is another name to be held in kindly 
remembrance, for he it was who, at about the 
same period, founded the modern pathology of 
tuberculosis. He held that inflammation never 
caused consumption, and also that hemorrhage 
was merely an incident of the disease. It was 
not without great difficulty that Boyle forced his 
views on the medical men of his time. Is it 
not a curious circumstance that less than one 
hundred years ago the most eminent medical 
men and, of course, all the people, believed hemor- 
rhage was the cause of consumption? However, 
it was an excusable mistake, since, as we know, 
a very large number of consumptives are first 
alarmed over their condition by a bleeding from 
the lungs. 

From Boyle's day onward, investigators be- 
came more active in studying the minute mani- 



1 6 Tuberculosis 

festations of the disease, but it was not until 
1868 that the profession as a body was compelled 
to change its belief that the disease was an he- 
reditary ailment. In that year a French army 
physician named Villemin first proved, beyond 
possibility of contradiction, that consumption 
is an infectious disease; in fact, a very slow and 
chronic fever, — and should be treated accordingly. 
He contended that experiment would prove the 
disease could, and would, reproduce itself. 

It was not until 1877, however, that its in- 
oculability was finally proved by the German 
scientist Cohnheim. You must understand that 
up to this time a terrific war of words had been 
waged between those who still clung to the 
theory of Heredity, and those who insisted the 
disease was infectious. 

Prior to this, in 1840, Dr. G. Bodington, of 
Warwickshire, England, gave his views on a 
combined system of treatment for consumption, 
which is closely followed by many to this day. 
He advocated a life spent in the open air, a 
liberal supply of proper food and the avoidance 
of excitement. 



The Turn of the Tide 17 

Nine years before Villemin's epochal paper was 
read before the French Academy, Brehmer had 
established a sanatorium in one of the most 
healthful parts of Germany, and was endeavor- 
ing to prove, by actual results, that with proper 
management and an abundance of fresh air the 
disease was curable. Up to his day, since Morton 
lived and taught the same theory, no one ap- 
parently held this view, or, at least, no one had 
the moral courage to defend it against the unan- 
imous contempt and ridicule of the medical 
world. ,s< *\ 

It is through the steadfast coiirage and tremen- 
dous energy and clear mental foresight of these 
men that the consumptive of to-day has a chance 
for recovery. In the face of all kinds of diffi- 
culties and the most acrimonious opposition, 
they, alone, stood out for the correct theory 
of the disease and its treatment along hygienic 
lines — theories and practice which to-day are 
proved correct by their success in every part of 
the world. 

Up to this time the champions of the theory 
of infection had labored under the difficulty of 



1 8 Tuberculosis 

not being able to produce the original cause of 
the disease. Their opponents asked them to 
prove consumption was an infectious ailment by- 
producing the agent of transmission — the germ 
that caused it. This they were unable to do 
for a long time. It was known that tubercu- 
losis begins as a growth of tiny whitish lumps 
on the lung tissue, but what caused these lumps 
was a mystery so profound that many acute 
investigators despaired of ever unravelling it. 
Probably hundreds took the sputum of afflicted 
patients and endeavored to find therein an 
active principle, or cause, for the disease; but it 
was elusive. 

All failed until 1877, when Klebs cultivated 
the virus of consumption on egg albumen. There, 
before his eyes, he saw growing in his culture 
tube a strange, fungus-like substance that 
rapidly spread over the albumen, even project- 
ing beyond the latter 's edges up the sides of 
the glass. He was the first man in the world 
to look upon the mysterious cause of consump- 
tion, and it was only by the barest chance he 
missed proving that this mold he had caused to 



Dr. Koch's Discovery 19 

grow in his culture tube was made up of count- 
less millions of germs, or bacilli. 

These germs cannot be seen in their native 
state even with the aid of the most powerful 
microscope. They must be stained red in order 
to become visible. Understand, up to this time 
no one knew there was a germ of tuberculosis. 
It was simply suspected to exist. How to bring 
it into view of the human eye was the problem 
confronting the scientists. 

After Klebs had shown the way, many other 
investigators succeeded in growing colonies of 
tuberculous germs on egg albumen, and all of 
them made efforts to discover of what this fungus- 
like growth was composed. It was not until 
1 882 , however, that the tubercle bacillus was finally 
separated from its fellows and brought to view 
individually under the microscope. Dr. Robert 
Koch devoted the best years of his life to find- 
ing a means of staining the individual consump- 
tion germ or tubercle bacillus. The germ itself, 
in its natural state, is perfectly transparent and 
is undistinguishable unless it is first prepared 
for examination by what is called a staining 



20 Tuberculosis 

process. By this process, the individual germs 
are stained red, while everything surrounding 
them takes on a blue color. 

It was Dr. Koch's privilege to find out how 
to properly stain the germ culture so as to make 
the bacilli, or germs, visible, and this one accom- 
plishment would have been enough to make his 
name immortal! No layman can have any 
idea of the immense amount of labor involved 
in determining the exact method necessary to 
bring these tiny little units within the scope of 
the human eye. Since Dr. Koch's work is done, 
any well-trained medical student can demon- 
strate the presence of the tubercle bacilli in a 
speciman; but previous to Koch's publishing the 
details of the process this task was greater than 
the combined intellect of the scientific world 
could compass. 

The champions of the theory of infection were 
now able to prove their case, for when asked to 
show the cause of consumption, they could 
point to that tiny rod, stained red in the field 
of the microscope, which, as Koch proved posi- 
tively, causes consumption: for consumption 



The Story of the Forty -eight Guinea Pigs 2 1 

is impossible in a human being unless this germ 
is present. Understand, it is not always found 
in every case! Sometimes the sputum (spit) 
of an acknowledged consumptive contains no 
bacilli, but this is not because the germs are 
absent from the lungs: it simply means that, 
for some reason or other, they are not being 
expelled. 

The opponents of the theory of infection were 
not entirely routed by the discovery of Koch. 
They were forced to admit that consumption, or 
tuberculosis, was a germ disease; but they con- 
tended, and with much show of reason, that the 
discovery of the germ did not prove it entered 
the body from the outside. They insisted that 
an hereditary tendency toward consumption 
might mean that the body was able to create 
these germs within itself spontaneously. In 
other words, the power to create the germ, which, 
by the way, is not of animal but of vegetable 
origin, was transmitted from father to son. It 
remained for Cornet to finally move these con- 
servatives from this last position. He advanced 
the view that the bacilli were dust borne, and by 



22 Tuberculosis 

a series of ingenious experiments proved the 
mode of infection to be as he supposed. 

In one of these experiments forty-eight healthy- 
guinea pigs were placed at various heights above 
the floor of a room in which a quantity of dried 
sputum was scattered about. The room was 
swept vigorously, and clouds of dust penetrated 
to every corner. After a proper interval the 
guinea pigs were dissected, and in all except 
one the lungs were found to be tubercular. It 
is due to this, and numberless other experiments 
of a similar character, that anti-spitting crusades 
are being carried on in nearly every civilized 
city in the world. It is supposed that the sputum 
dries on the sidewalk, and is carried by the wind 
into the lungs of healthy persons, infecting the 
latter just as the guinea pigs were infected in 
Cornet's experimental chamber. 

In such cases the test known (to physicians) 
as the albumen test is of much value in deter- 
mining the true nature of the disease. 

About the same time Cornet was carrying on 
his experiments, Flugge, another German scien- 
tist, was endeavoring to prove that the coughing 



Flugge Proves Droplet Infection 23 

and sneezing of tubercular individuals was the 
means of carrying the disease to non-infected 
people. By a series of experiments, never sur- 
passed for delicacy and difficulty, he eventually 
proved that when a consumptive coughs un- 
restrainedly into the air, he projects minute 
droplets which carry germs which may remain 
floating in a room where the air is undisturbed 
as long as ten hours, and carry a distance from 
their original source of from fifteen to one hundred 
feet. It is because of Flugge's experiments 
that modern consumptives are instructed to 
hold a cloth, or at least their hand, before their 
mouth when coughing or sneezing. 

At about the time Koch discovered the tu- 
bercle bacilli, Behring and other scientists were 
developing serum-therapy, or the treatment of 
germ-caused diseases by blood liquor, or serum, 
taken from animals purposely inoculated by 
the particular germ of the disease to be treated. 
These serums were found to act as antidotes to 
the poisons generated by the disease germs 
within the infected person. One of these serums, 
the diphtheria anti-toxin, had proved so wonder- 



24 Tuberculosis 

fully effective that the profession turned to 
this form of treatment with unanimous accord, 
convinced that, at last, had been found the way 
to cure every infectious disease. An anti-toxin 
for tuberculosis was eagerly sought, and a few 
years later Koch's Tuberculin was brought to 
the notice of the profession, and, backed by 
the great name of its discoverer, offered to the 
world as the cure for tuberculosis. 

Why Tuberculin did not come up to anticipa- 
tions will be explained elsewhere. I merely men- 
tion it here as the last event in the formal history 
of Tuberculosis. 

The partial failure of Tuberculin threw back 
the treatment of tuberculosis almost to where 
it was left by Hippocrates. What a comment 
this circumstance is upon the disappointments 
that attend human endeavor. After thousands 
of years of study, after the expenditure of an 
incalculable amount of labor, although man had 
advanced to an intimate knowledge of the disease, 
and its mode of causation, that far more impor- 
tant question, how to cure it, still begged an 
answer. 



: 



Slh- 




PLATE I. 

Illustrating the normal position of the internal 



organs. 



The Search for a Cure Renewed 25 

Busy minds pursued the inquiry, however, 
with unflagging zeal. Hardly a day passed but 
some physician proposed a new remedy. In 1886, 
Cavagnis claimed good results with a mixture 
of sputum and phenol. In 1897 Lemery and 
Schroeder prescribed the cooked and powdered 
lungs of a fox. Jaeger and Burnett administered 
powdered human lung, and, in 1893, Rodet recom- 
mended tubercular glands as a sovereign remedy. 
Richet and Varicourt used muscle plasma, and 
other things highly recommended at the time 
by their advocates were the various secretions 
of particular animals, especially the blood of 
dogs and goats. As late as 1906 Peter Patterson 
prescribed the broken-down caseous part of the 
diseased lung, and in the same year, Krause 
injected into his patients sterilized sputum. 
None of these so-called remedies secured any 
recognition among the profession at large and 
have gradually been forgotten. 

In the endeavor to discover a cure for tubercu- 
losis, the bacillus itself has been subjected to in- 
numerable analyses. It has been split up into 
its component chemical parts a thousand times 



26 Tuberculosis 

in the hope that the result of such analysis would 
be the discovery of an active principle, which 
could be used in concentrated form to combat 
the disease. 

It was during these later years of world-wide 
investigation that Dr. Yonkerman, of Kalamazoo, 
Michigan, U. S. A., began his experiments. One 
of his experiments was performed on a number 
of cattle, which had been condemned by the 
State Live Stock Sanitary Commission as tubercu- 
lous. Treatment was administered to these 
animals for several weeks by Dr. Yonkerman, 
when they, having apparently recovered, were 
killed, and post-mortems performed. The sur- 
geons making the experiment were astounded 
to find the supposed tubercular organs com- 
pletely healed and apparently sound and service- 
able. 

Dr. Yonkerman next experimented upon 
himself, in order to prove that the medicines 
used produced no bad effects when taken within 
the human body. On the contrary, these in- 
vestigations demonstrated its influence was 
decidedly beneficial. 



Tuberculozyne an International Remedy 27 

Success still attending these researches into 
the nature of the new remedy, Dr. Yonkerman 
was persuaded to permit it to be used in a num- 
ber of cases of lung trouble in human beings. 
The results again establishing the efficacy of the 
treatment beyond doubt, Dr. Yonkerman was 
strongly urged to take such steps as would place 
it within the reach of the public at large, and 
the method of treatment now known the world 
over as the "Tuberculozyne System of Treat- 
ment" is the result. 

Since that day, because of its low cost and the 
wide publicity it has received, hundreds of suf- 
ferers in all stations of life and in nearly every 
country in the world have experienced its benefits, 
as is shown by the records and personal state- 
ments of patients who have recovered from the 
various forms of lung trouble, including many 
serious and advanced cases of tuberculosis. 

Until the true character of tuberculosis was 
understood, and Cornet and Flugge had shown 
the method of its transmission from one person 
to another, no scheme of prevention, or prophy- 
laxis, was recommended, or even imagined. 



28 Tuberculosis 

Afflicted persons expectorated, coughed, sneezed, 
and otherwise disseminated the germs, unre- 
strained by either personal or social considera- 
tions. It is now well understood by those who 
are informed, that the most dangerous person in 
a community to-day is a wilful, perverse, or 
ignorant consumptive; a person who, knowing 
that he is scattering the seeds of the disease, 
deliberately continues to do so. 

As a consequence of the danger which improp- 
erly cared for sputum unquestionably is to the 
community at large, the authorities have seriously 
considered repressive and coercive measures, 
directed at the individual consumptive; and in 
certain quarters these protective measures have 
been put into effect and are being administered 
by the authorities with absolute impartiality. 

All commend restraint of such diseases as 
cholera, smallpox, etc., for the reason that these 
diseases are self -limiting. Not under any cir- 
cumstances do they last more than a few weeks, 
and then the patient is released from the strict, 
but wholesome, regulation to which he has been 
subjected by law; but consumption is a chronic 



The Consumptive vs. The Community 29 

disease that persists, in the majority of cases, for 
the better part of a lifetime, unless the disease is 
arrested and cured by a proper system of treat- 
ment. 

Unless consumptives themselves prevent its 
spread it will probably always exist, through the 
scattering abroad of the germs produced in their 
own bodies, and therefore if we are to conquer it 
— make it as rare as the black typhus which deci- 
mated Cities and States a few hundred years ago 
— consumptives must stop their promiscuous 
spitting; but that done, the chief and practically 
only danger of consumptives to their healthy 
associates is abolished. 

There is, of course, the possibility of contract- 
ing Tuberculosis through infected milk and meat 
from cattle afflicted with Bovine Tuberculosis, 
as has been proven by a long series of investiga- 
tions made by the Royal Commission appointed 
by the late King Edward of England to study the 
relation of Human Tuberculosis to BovineTuber- 
culosis and to ascertain if the disease can be com- 
municated from animals to man. 

In an exhaustive report the Commission states 
that it found that Bovine Tuberculosis was a dis- 
tinct and separate disease from Human Tubercu- 



30 Tuberculosis 

losis and expressed the conviction that it is com- 
municable to man. Therefore, great care should 
be constantly taken to avoid using milk and meat 
that may have come from infected cattle. 

The ideal place to do battle with tuberculosis 
is at home, where, surrounded by familiar sights 
and affectionate friends, the patient can concen- 
trate all his energies on the conquest of the dis- 
ease. 

A consumptive, especially one in the earlier 
stages of the disease, is, everything considered, 
far better off in his own home than he would be 
in the average sanatorium, provided he is prop- 
erly advised how to order his daily life, and has 
sufficient interest in his own welfare to follow in- 
structions faithfully. This is my conviction, and 
I believe the conviction of the profession as a 
whole ; excepting, of course, in particular in- 
stances. 

If proper treatment is begun in time, there is 
no question about the curability of tuberculosis. 
In the accompanying appendix are given records 
of a number of remarkable cases, all treated suc- 
cessfully at home, and these are but a few of the 
many hundreds of similar cases treated with the 
Tuberculozyne System of Home Treatment. I 



The Ubiquity of Tuberculosis 31 

would not have it inferred, however, that all cases 
of consumption can be cured; for while it is true 
that, taken in time, there is every reasonable 
hope that progress of the disease may be arrested 
and the patient recover, it is just as true that if 
treatment is delayed too long no power on earth 
can save. 

Statistics show that consumption and asso- 
ciated lung diseases are the commonest of all ail- 
ments. A record of the mortality among mem- 
bers of the Prussian Catholic Orders, during a 
period of twenty-five years, and embracing 74,306 
persons, showed two-thirds of them died of 
tuberculosis. In England there are 60,000 deaths 
a year, and in America 150,000 deaths are annually 
attributed to this one disease, tuberculosis. 

It is estimated that there are a million and a 
half people unquestionably affected by the dis- 
ease in the United States. If these figures are 
correct, one person in every fifty is a consump- 
tive, with the symptoms of the disease sufficiently 
definite to make diagnosis easy. But this does 
not tell the tale. The authorities are of the 
opinion that in every civilized community not 
one person in fifty, but nine persons in every ten, 
are infected with the disease at some time or 



32 Tuberculosis 

other during their lives. Nagali kept a record 
of the number of times he found evidences of 
tuberculosis in the lungs of persons who had died 
of other diseases. The extraordinary result of 
this investigation was that nine out of ten showed 
traces of the disease. 

Many bad colds, so called, are now considered 
to be of tubercular origin. This belief has not 
yet penetrated to the public, to whom a cold is 
still a cold and nothing more ; but we can see that 
a very much larger proportion of the people must 
be prone to this disease than has hitherto been 
suspected, by what happens when some pro- 
foundly depressing influence sweeps over a com- 
munity or nation. 

One of the most potent wide-spread influences 
of this character is la grippe or influenza. This 
disease, which at the height of some of its worst 
visitations has had practically the entire civilized 
world at its mercy, never fails to raise the death- 
rate of tuberculosis to an appreciable extent. In 
1 89 1 an epidemic of influenza started in Russia 
and within six weeks had reached America. That 
same year the death-rate in Chicago, one of the 



The Half Brother of Tuberculosis 33 

healthiest cities in the world, was far higher 
than it had been for years, or has been since. 

Influenza has a powerfully depressing effect 
upon the human system. Even the most robust 
health is apparently no protection from its rav- 
ages. Some of the strongest people succumb to 
it the easiest, and there is little doubt that thou- 
sands of slightly affected tuberculous people are 
hurried to their graves through the pernicious 
activity of this mysterious ailment. Dr. Seth 
Scott Bishop, in writing of influenza, uses the 
most emphatic language. He says, it is more to 
be feared than smallpox or cholera; "when it does 
not kill, it blights and withers and leaves its 
deadly sting to blot out one's sight or hearing or 
reason, or sows its deadly seeds in other organs 
to ensure its victim's future maladies." 

Many people think influenza is a modern dis- 
ease chiefly because the epidemic of 1890 was 
given such wide publicity in the newspapers. As 
a matter of fact, influenza is as ancient as tuber- 
culosis. History records that the Athenian army 
in Sicily was ravaged by this mysterious plague 
of the nose, throat and lungs to such an extent 



34 Tuberculosis 

that it almost brought the campaign to an in- 
glorious end. In 1510 a terrible epidemic of 
influenza visited the British Isles. The British 
are said to have died like moths in the flame of a 
"murrain that passed over the land like an angel 
of death locking men's breath in their bosoms." 
All told, there have been recorded twenty severe 
outbreaks of this disease, as well as innumerable 
minor ones. 

The cause of influenza is unknown, but its 
symptoms and effects have been so carefully 
studied that little else remains to be discovered. 
We find it aggravated by peculiar weather; and 
long periods of depressing atmospheric conditions 
are usually found contemporary with an epidemic 
of this disease. Some suppose it is carried by 
volcanic dust, and that severe eruptions will 
always be followed by a local or general increase 
in the number of cases. After the outbreak of 
Mt. Pelee influenza was much more severe on 
the American Continent than it had been for 
years previous. How it is caused and propagated, 
however, is merely interesting and not practically 
important as far as the scope of this book is con- 



Influenza and Tuberculosis 35 

cerned. The point is that it produces in the lungs 
and air passages conditions considered ideal for 
the development of tuberculosis. 

The germs of influenza (for it is generally con- 
ceded to be a germ disease) cause swelling of the 
air passages, including the finer or more remote 
bronchial tubes. Ordinarily the human body is 
well protected from invasion by tubercle bacilli; 
but when the inflammation set up by influenza 
has weakened the resistance of the local mem- 
branes, the germ of consumption finds little or no 
opposition in the tissues, and consequently pros- 
pers accordingly. The vitality of the "grip" 
victim is far below a normal standing, and under 
such circumstances the possibility that tuber- 
culosis will make serious inroads before it is dis- 
covered, or even suspected, is increased. 

In the presence of influenza two things may 
happen: either at that time the tubercle bacilli 
gain entry and secure lodgment in the body, or 
bacilli already in the lungs or air passages are 
encouraged to develop. 

If, as Nagali reported and many authorities 
believe, nine people out of every ten have a touch 



36 Tuberculosis 

of tuberculosis at some time or other during their 
life, it will be readily seen that an attack of in- 
fluenza is a period of some danger. Therefore, 
even if influenza were not one of the most debil- 
itating and distressing ailments we have, it should 
never be neglected, however mild, for there is no 
way of telling whether in any given case it is asso- 
ciated with tuberculosis or not. If it be, and the 
tuberculosis is of a slow type, we may have one of 
those cases of influenza, common enough, as 
everybody knows, which the sufferer, as the public 
usually expresses it, "never gets over." 

Lingering cases of influenza may be tuberculous 
in character. The tuberculosis, in such a case, is 
likely to be of a mixed, obscure or generalized 
type; to wit: such la grippe or influenza invalids 
often complain of after-effects of their ailment, 
such as loss of functional power, running of the 
ears, gradually increasing weakness, mild bron- 
chitis, head pains, continuous fatigue, affections 
of the joints and muscles, and, especially, stomach 
trouble. 

It should be noted that practically all these 
general symptoms may be found in the tubercu- 



Dyspepsia in Lung Trouble 37 

lous. What I mean is, that not all these symp- 
toms will be found in a majority of cases, but that 
some one, or more than one, of them will be found 
in the consumptive person. The stomach symp- 
toms are particularly important. Von Behring, 
one of the greatest physicians the world has ever 
known, claims that tuberculosis always gains 
entry into the system through the stomach, 
and there is no doubt that a vast amount of tuber- 
culosis begins with the symptoms of dyspepsia. 

Since influenza begins with, or develops, 
symptoms practically identical with those seen 
in a dyspeptic type of incipient tuberculosis, any 
person who is afflicted with stubborn indigestion, 
after an attack of influenza, should take immediate 
measures to recover his health, by adopting a 
thorough course of treatment calculated to build 
up the strength and increase the vitality to a 
normal standard ; for, as far as we know, no man 
on earth is able to say positively that such a case 
is not incipient tuberculosis. Remember this: 
tuberculosis may be present, and even consid- 
erably advanced, and yet no examination of the 
sputum will prove its existence. Nevertheless, 



38 Tuberculosis 

there is no truth in medical science, so absolutely 
beyond controversy, as this which follows in 
Lindsay's language: "The greatest hope of the 
consumptive consists in the early detection and 
immediate radical treatment of his case." 

The Tuberculozyne System of Treatment is 
designed to meet just such indefinite cases as 
these and is recommended where doubt exists as 
to whether the affliction is actually incipient 
tuberculosis or one of sore and sensitive condi- 
tions of the lungs and air passages due to non- 
tuberculous causes. It can therefore be used by 
the influenza sufferer with the confident expecta- 
tion that he will receive decided benefit. If the 
case is one of influenza, pure and simple, the 
patient should be as anxious to recover from it 
completely and absolutely as if he knew that it 
was complicated with tuberculosis; for, as Dr. 
Bishop points out, even if it does not develop 
into tuberculosis, it may result in some other 
lasting injury to the health, almost, if not quite, 
as serious. On the other hand, though it may 
not be provable, if the influenza be complicated 
with tuberculosis, the patient has the satisfaction 



Catarrh and Tuberculosis 39 

of knowing that the Tuberculozyne System of 
Treatment comprehends both the tuberculous 
and non-tuberculous affections of the air pas- 
sages. 

What has been said regarding the relation- 
ship of influenza and consumption might be 
applied word for word almost to catarrh and con- 
sumption. 

Both influenza and catarrh are accompanied 
by stomach disturbance. Tuberculosis often be- 
gins as a dyspepsia. The catarrhal symptoms of 
the three are identical in many cases. When can 
we say that an influenza with stomach disturb- 
ance, or a catarrh with stomach disturbance, is 
not the dyspeptic type of tuberculosis, with 
catarrhal symptoms? It is a very difficult 
situation for the diagnostician. What shall we 
say, then? That a case of ordinary catarrh with 
associated stomach trouble is not tubercular 
unless bacilli are found in the sputum? Un- 
doubtedly if we took this position we would be 
correct in a large number of cases, but which cases? 
How would we be able to distinguish the non- 
malignant from the malignant symptoms? 



4-0 Tuberculosis 

Another fact should be taken into considera- 
tion : the bodily health is never prime in the 
person who is catarrhal. The catarrh itself is 
proof that the vitality has been lowered, and iden- 
tically the same constitutional condition would 
be present if the hawking, spitting and running 
of the nose were of a tubercular origin and not 
common, ordinary catarrh, so-called. 

If influenza, through its debilitating effect upon 
the air passages, is a common source of danger 
to those who are inclined toward lung diseases 
in general and tuberculosis in particular, it seems 
to me also important that catarrhal symptoms 
should be given due consideration and early 
treatment. 

Dr. Camac Wilkinson states the case in the 
following extract from his book on Tuberculosis: 

"I found again and again, in the history of 
my cases, that in the early stages of their disease 
they had consulted a specialist for the throat, 
and he had told them that they had catarrh, but 
it was NOT serious. The terrible sequel in at 
least a score of cases that consulted me a year 
OR more afterwards should be an everlasting 




PLATE II. 

Illustrating the distribution of the bronchial tubes 
in a normal lung. The light-colored branching tubes 
are the bronchial tubes, and the blue color indicates 
a part of the pulmonary artery. 



The True Nature of Some "Colds" 41 

warning to those specialists, who on a haphazard 
diagnosis called the first stage of tuberculosis 

BY THE FALSE NAME OF CATARRH." 

In an appreciable percentage of cases of early 
tuberculosis, the disease first manifests itself as 
a succession of colds in the head. "Colds" are 
simply another name for catarrh. But this kind 
of "cold," this sort of catarrh, is serious indeed, 
though not so considered at first. Later on, 
when these nasal catarrhs or "colds in the head" 
penetrate deeper into the lung structure and be- 
come "colds on the chest," their true nature is 
more obvious. 

There are many people who have colds at 
regular seasons every year. With each repeti- 
tion these colds become a little more stubborn. 
Finally there comes a year when the cold does not 
break up as usual with the advent of warm 
weather, but persists into, and perhaps through, 
the hot months of summer, causing considerable 
doubt and apprehension in the mind of the suf- 
ferer. Not a few of these people call them- 
selves "hay-fever" victims, for there is a spring 
hay-fever as well as a fall hay-fever, remember- 



42 Tuberculosis 

After cough and chest pains or soreness develop, 
many such cases eventually visit the doctor, 
with the request that he cure them of their 
bronchitis. They see the trouble has gone be- 
yond a simple catarrh, and their natural conclu- 
sion is that bronchitis has developed. It may 
very easily be bronchitis, for bronchitis is simply 
catarrh of the bronchial tubes. On the other 
hand, it may be tuberculosis, as Dr. Wilkinson 
very plainly declares. This is the unfortunate, 
because unsuspected, situation of some of the 
people who neglect periodical colds in the head. 
What is to be done in such a case as this? Treat 
the bronchitis, so-called, symptomatically with 
rock and rye and a chest pad, or go in at once 
for a searching, deliberate, comprehensive system 
of treatment ? The latter may not cost any more, 
if as much; and if it result in a perfect recovery of 
health, such a result will be its own justification 
to whatever man-given name (bronchitis or 
tuberculosis) the original lung disturbance was 
entitled. 

We record with reluctance, nevertheless record 
it we must, on the authority of the most eminent 



The Time to Treat Tuberculosis 43 

men in the medical world today, that the ma- 
jority of cases of tuberculosis in its early stages 
are known by some other name. 

I do not wish to make it appear that every 
little cold is tuberculosis: this is not my inten- 
tion. What I do wish to emphasize is the vital 
fact, paradoxical as it may seem, that the time to 
begin the treatment of tuberculosis is, emphatic- 
ally, that time when it cannot be told with cer- 
tainty whether the disease is present or not. 

There is just this to be said about it. If the 
case be one of incipient tuberculosis, and the 
attack is so mild that all methods of diagnosis 
fail, or the symptoms are so trifling as to raise 
not even an idea of tuberculosis, it may go on 
gradually getting a little worse from day to day, 
or month to month, but not so radically worse 
as to cause real anxiety, until suddenly confronted 
by the telltale hemorrhage, an awful chill grips 
the heart of the victim. Then what would they 
not give for those wasted months when the dread 
visitant might have been stayed, or altogether 
overcome, and perhaps with comparative ease! 

This would mean that every case of stubborn 



44 Tuberculosis 

catarrh, every case of bronchitis, every case of 
influenza should be treated by the most scientific 
system of treatment obtainable for the lungs. 

The catarrhal inflammation may advance up 
the eustachian tubes, which are the little pas- 
sages leading from the throat to the ear cavity. 
These tubes are barely the diameter of a fine 
bristle, and therefore a very slight catarrhal in- 
flammation is sufficient to close them entirely. 
Then what do we have? Ear noises, sounds like 
the ringing of bells, hammering on anvils, the 
agonizing sensation of a ceaseless dropping of 
water. Or, perhaps, the catarrh may become 
hypertrophic, in which case the tender turbinated 
bones which you can feel with your little finger 
may become diseased and rot away. Or, we may 
have a thickening of the vocal cords, known by 
the name of "clergyman's sore throat," which in 
the case of people who earn their living by means 
of the voice may be a very serious matter indeed. 

Whether these serious consequences even- 
tuate or not, catarrh is always an embarrassing 
ailment, and often accompanied by an offensive 
breath. 



A Mimicry of Bronchitis 45 

If the catarrhal mucus is not expelled from the 
mouth, it drops down into the throat, and gener- 
ally is swallowed, especially during sleep. Upon 
reaching the stomach, being highly obnoxious to 
that organ, it results naturally in a form of in- 
digestion, which of course, cannot be wholly re- 
lieved until the cause is removed. At first mild, 
this dyspepsia tends to grow worse in time, and 
becoming a settled condition, so to speak, of the 
digestive organs, may persist even after the ca- 
tarrhal symptoms have disappeared. 

When the catarrhal inflammation penetrates 
into the large bronchi, and particularly into the 
middle bronchi, or air passages of the lungs, 
we call it bronchitis. If mild, according to Lind- 
say, the symptoms of bronchitis have little signif- 
icance, but if they become more severe, he says, 
they may point, not to a beginning of consump- 
tion merely, but to a wide and serious tubercu- 
lization of the lung. In such a case the "pa- 
tient presents some of the usual bronchial symp- 
toms — cough, expectoration (spitting), shortness 
of breath, or pain in the chest; but there are no 
physical signs." In other words, to all intents 



46 Tuberculosis 

and purposes, a true case of tuberculosis is imi- 
tating all the ordinary symptoms of a non-tuber- 
cular bronchitis. 

Sometimes it is very difficult to make the dis- 
tinction. The leading differences are: in bron- 
chitis the chest is often rounded, in consumption 
flat and depressed; in bronchitis the pain is us- 
ually on both sides of the lung, in tuberculosis, if 
there be any pain, it is usually confined to one 
side, and is then observed, either just below the 
collar bone, under the shoulder blade, or as a 
sort of girdle pain extending from the shoulder 
round the body under the arm pits just above the 
waist. 

On a general survey of a minor case of bron- 
chitis nothing appears to be changed. But as the 
disease gains in severity the face may become 
swollen, and the cheeks, lips, ears and finger- 
tips assume a bluish tinge, which deepens character- 
istically on slight exertion. The patient often 
pauses for breath when speaking and talks in a 
disconnected manner. A person in an advanced 
tubercular condition seldom suffers in this way, 
although in the earlier stages of the disease the 



The Gravity of Capillary Bronchitis 47 

disturbance in breathing and speaking may be 
very similar to that just described as character- 
istic of bronchitis. 

A very expert physician might be able to dis- 
tinguish a bronchial cough from one due to tuber- 
culosis, but it requires a fine ear, and any attempt 
to rest a diagnosis upon this symptom is apt to 
end disastrously, because the cough is so similar 
in tubercular and non -tubercular inflammatory 
conditions that even the long training and con- 
stant opportunities of the specialist would not 
justify any reliance on the sound, frequency or 
intensity of a cough as a means for diagnosis. 

Unfortunately the sputum is quite as mis- 
leading as the cough. Certainly the expectora- 
tion of bronchitis is likely to be tough, scanty and 
viscid, while that of tuberculosis is usually rather 
free and easily produced; but on the other hand, 
the bronchitis sputum may be almost identical 
with that of consumption so far as its external 
appearance is concerned, even to the trained eye, 
loose, abundant and of a reddish, greenish or 
yellowish tinge. 

The latter type is most likely to be found in 



48 Tuberculosis 

cases of bronchitis which have been neglected 
until the inflammation has penetrated the finer 
air passages or capillaries. How fine and delicate 
these tubes are may be judged from the fact that 
the red blood corpuscles are forced to travel 
through the adjacent arterioles in single file. In 
other words, they are infinitely finer than a hair 
and yet so perfect in their action that, when the 
individual is in a state of health, they perform 
their duty of helping to aerate the blood contin- 
uously. 

When the catarrhal inflammation penetrates 
these tiny capillaries, it throws everything into 
disorder. The walls of the tubes lose their firm- 
ness and bulge outward. In the space thus 
formed, the inflamed membrane deposits con- 
tinuously a secretion which gathers gradually 
until the cavities are rilled; then the accumula- 
tion produces an irritation of the local nerves, 
and the patient secures relief by a severe fit of 
coughing. This sometimes lasts for a consider- 
able period, during the course of which a quantity 
of foul-smelling, disagreeable-looking, greenish, 
reddish, or yellowish sputum is either discharged 



The Treatment of Bronchitis 49 

from the mouth, as is proper, or, as has been 
said before, is swallowed with disastrous conse- 
quences. 

In an advanced case of this character, the chest 
may sink in at its lower extremity or around the 
base of the sternum, commonly called the breast- 
bone, and the spaces between the ribs also may 
become quite prominent. Here we have a char- 
acteristic picture of the tubercular chest, al- 
though as a rule the latter usually begins to sink 
below the collar bone or on one side of the body 
only. In tuberculosis the lower portion of the 
chest is not usually depressed until the disease is 
very far advanced. 

The treatment of chronic bronchitis is almost 
identical with that of advanced tuberculosis. The 
patient is instructed to clothe himself warmly, 
and to avoid the inclemencies of the weather. At 
the same time he must keep in the open air as 
much as possible, and breathe deeply at all times 
of pure fresh air. 

The diet of a bronchial person is chosen with 
the same purpose in view as governs the regula- 
tion of that advised in cases of tuberculosis. 



50 Tuberculosis 

Both of these forms of lung inflammation are a 
severe strain on the constitution, and the strength 
of the patient must be maintained at all hazards. 
The diet must have an immediate effect on the 
nutrition of the entire body. It must also be of 
such a character as to be acceptable to the stomach 
and free from gas-forming elements, for the simple 
reason that in bronchitis, as in tuberculosis, 
stomach disturbances are often quite marked, 
and may interfere seriously with the progress of 
the patient toward recovery. 

The medical treatment employed is much the 
same in these two types of lung inflammation, 
and has for its chief purpose the increase of bodily 
strength and vigor and the healing of the inflamed 
tissues. 

A person suffering with an uncomplicated 
bronchitis can, consequently, adopt the Tubercu- 
lozyne System of Treatment with every reason- 
able expectation of its acting in his case favorably. 

The Tuberculozyne System is not a one-med- 
icine treatment, which the patient takes in tea- 
spoonful doses after meals, three times a day, as 
per the usual plan; but it consists of tubercu- 



The Tuberculozyne System 51 

lozyne, which is the chief item in the treatment, 
and also a complete management of the case, 
including full instruction as to diet, mode of life, 
sleeping, bathing, etc. 

In short, nothing that can contribute to the 
welfare of the patient is omitted, and the patient 
is assured that in adopting this treatment he will 
receive the benefit of every measure, hygienic or 
medical, which the long experience and intimate 
knowledge of the disease possessed by the physi- 
cian in charge of the case indicates as valuable 
and necessary. 

There is such a thing as false tuberculosis and 
false bronchitis. Such imitative symptoms are 
of a hysterical character, and usually exhibited 
by persons of a highly nervous temperament with 
other hysterical symptoms, such as dizziness, phan- 
tom pains, erratic ideas, and a generally unbal- 
anced condition, and are a more or less common 
occurrence. In these cases there is no actual 
tubercular disease, not even a positive catarrhal 
condition of the lungs, but the symptoms of these 
two diseases are very much in evidence. There 
may be expectoration, spitting, cough and a very 



52 Tuberculosis 

decidedly rundown condition of the entire system. 
The patient may even lose weight persistently, a 
symptom very certain to be attributed to tuber- 
culosis under the circumstances. If the case is 
examined carefully, however, it will be found 
there are no variations in the temperature, no 
rise at night, and no fall in the morning, as there 
would be if a moderate tubercularization of the 
lung were present. These cases, however, are 
quite rare. 

The most striking difference between a true 
consumptive and the false, hysterical case is that 
the latter is moody in mind, downhearted and 
well-nigh despairing. The patient dwells upon 
his symptoms day and night, imagining the direst 
consequences and anticipating death, no less. 
On the other hand, after the first few weeks of 
depression, the average true consumptive re- 
covers his buoyancy of mind, and is thereafter 
sanguine and hopeful. No doubt you can recall 
instances of people who succumbed to the disease, 
whose last words almost indicated perfect faith 
in their eventual recovery. 

I have mentioned this peculiar nervous variety 



The Neurasthenic Decline 53 

of pseudo-tuberculosis, because it is sometimes 
mistaken for true tuberculosis. They are thin, 
weak, coughing, complaining invalids. They suf- 
fer on account of their nervous symptoms as 
keenly as though they were actually infected; 
nay, some seem to suffer more. These people 
will never get well unless the situation is explained 
to them, and they come to see the necessity for a 
careful and systematic building up of their ner- 
vous systems. When their nerves have been 
made strong and vibrant once more, the lung 
symptoms, of course, will disappear. 

They can take, as they do, quantities of cough 
medicine and not benefit a particle; and after that 
statement it will seem strange for me to recom- 
mend the Tuberculozyne System of Treatment to 
this class of patients. I do so because the Tuber- 
culozyne System is essentially a strength-builder. 
Tuberculosis is fought by increasing the nutrition 
of the system as well as by destroying and re- 
moving the tubercle germ. The patient must be 
fed and fortified. His vitality must be increased. 
This is accomplished by adopting such measures 
as are best calculated to cause the digestive organs 



54 Tuberculosis 

to do their full duties. When digestion becomes 
normal and complete, the food is turned into 
powerfully re- vitalizing elements. The part of 
the body that feels the benefit of such a fortifying 
method of treatment before all and more than all 
other parts is the nervous system. The nerves of 
the hysterical patient, among whom, by the way, 
women largely predominate, are erratic, unreli- 
able, or pain-causing, because they are underfed. 

The proper way to treat neuralgia, for instance, 
is to increase the digestive power of the patient. 
A nervous case is often complicated by a ca- 
tarrhal inflammation of the nose. In such instances 
the direct action of the Tuberculozyne System of 
Treatment on the air passages themselves tends to 
relieve annoying symptoms more rapidly than 
would be possible with any less complete and 
comprehensive method. 

Some of these nervous cases eventually become 
asthmatical. Asthma is now generally acknowl- 
edged to be a nervous disease. The nerves be- 
come irritated, as it were, and when their natural 
resistance is reached, react in the shape of a spasm, 
which closes the air passage. The suffocating 



Asthma and Nervous Disease 55 

symptoms known as the asthmatic paroxysm 
result. For some unknown reason attacks of 
asthma usually come on in the early morning 
hours. They begin with a tightness in the chest, 
a short dry cough, a wheezing and whistling of the 
breath, and much anxiety of mind. The inspira- 
tion, or dra wing-in of the breath, becomes either 
very short or is much prolonged, and the patient 
gasps and pants in a pitiable fashion. His 
face grows swollen and purple, tears run from 
his eyes, and his body is bathed in perspiration. 
He may sit on a chair with the back grasped in 
his two hands. This position is assumed because 
it helps the sufferer to bring all the muscles of 
respiration into play. An attack usually lasts 
from one to six hours. Then the symptoms 
gradually subside; cough returns, and the expec- 
toration becomes more abundant. The patient 
spits up peculiar little pellets of gray mucus, which 
are so round, firm and translucent that the}^ have 
been given the popular name of "asthmatic pearls." 
The Tuberculozyne System of Treatment has 
been used with success in asthma, because it is a 
scientific treatment designed to remedy the ner- 



56 Tuberculosis 

vous disturbance which is the exciting cause of the 
trouble. Asthma is a disease on which quacks 
flourish, for it is easy to dull the irritated nerves 
by means of opiates, such as morphine, opium 
and chloral. Many asthmatics, after taking such 
remedies a week or so, become very enthusiastic 
over the results, for it seems as though their ail- 
ment was entirely overcome, and that most 
easily and pleasantly. For the first two or three 
weeks the opiates have a delightful effect on the 
nervous system, giving it a calmness and peace 
most uncommon. But we know that this is a 
deceptive state of affairs. Soon these opiates, so 
innocently taken into the system, will begin to 
bring it under their harmful influence. 

A habit may be formed, worse by far than the 
original disease. Now the patient finds himself 
on the horns of a dilemma. If, realizing the effects 
of his remedy are worse than the ailment, he en- 
deavors to discontinue the former, he may either 
find himself unable to do so, or threatened, if he 
does succeed, with a return of the asthma in a 
form more severe than before. 

Hence, a sufferer from asthma should avoid 




PLATE III. 

Illustrating the exterior surface of the normal 
lung; the dark lines indicate the division of the lung 
into three parts — the upper, middle, and lower lobes. 
The left lung has but two lobes. 



Eeware of Habit -Forming Drugs 57 

bottled "dope" of this character with the greatest 
circumspection, because more often than not it 
contains drugs very deleterious to health. 

Regularly qualified physicians only should be 
given charge of such cases, and preferably they 
should be men who are specialists in ailments of 
the pulmonary cavity. 

Tuberculozyne Treatment contains no opium, 
chloral, morphine or similar narcotics. Under no 
possible circumstances can it produce a habit! 

It is a wholesome system of treatment com- 
bining the best hygienic measures known to the 
profession, and its medicines are not designed to 
smother up symptoms by deadening the nerves, 
but to reach the cause of the disease. 

There is another common lung ailment which 
should be mentioned in this connection, because 
of its common association with tuberculosis. 
This disease is known as pleurisy. 

The most striking symptom is a severe, cutting, 
lancinating pain in the chest, felt usually just 
below the breast on either or both sides of the 
thorax, whenever the patient attempts to breathe 
a little deeper than usual. As a consequence, a 



58 Tuberculosis 

person suffering with pleurisy breathes as shallow 
as possible, and makes his inspirations and ex- 
pirations so short that he does not seem to be 
breathing at all. He also hunches his shoulders, 
and contracts his chest, with the object of min- 
imizing the pain as much as possible. 

Pleurisy is an inflammation of the serous sac 
which surrounds the lung and also the lining 
membrane of the thorax. In health this mem- 
brane secretes a thin fluid, which enables it to 
glide easily over the adjacent parts when the lungs 
move up and down. Pleurisy interferes with 
this arrangement, and causes the membrane to 
become extremely sensitive. 

The relationship of pleurisy to tuberculosis is a 
much debated point, but a very important one. 
Lindsay says: The relationship of this disease to 
consumption is "one of the most vital outstand- 
ing question's of practical medicine." It has not 
been decided as yet whether or not pleurisy is 
caused by the tubercle bacilli. It is the one 
question the profession would like very much to 
settle, for a very large number of people suffer 
with pleurisy every season, and if it could be 



Is Pleurisy a Warning? 59 

positively determined that it was always tubercu- 
lar then it would be possible to begin antitubercu- 
lar treatment at once, without waiting for any 
other later sign of the disease. In other words, 
pleurisy would constitute one of the earliest, if 
not the earliest sign of tuberculosis, and make it 
possible by its timely warning to save many a 
case that is now neglected until it has become in- 
curable. 

Unless the result of some accident or injury to 
the chest, or an acute attack, it is very generally 
an attendant in intracellular disease of the lung. 

There is much difference of opinion as to the 
percentage of cases of pleurisy which eventually 
develop signs of tuberculosis. The more conserv- 
ative investigators say one-third; others declare 
this proportion too low, and place the figure at 
one-half. The great Landouzy insists that 98 
per cent, of all cases of pleurisy not only develop 
tuberculosis, but are tuberculous in origin. If 
what he says is correct, and this man made a 
special study of this particular phase, then no 
case of pleurisy should be neglected or given 
merely local treatment. It should be placed 



60 Tuberculosis 

on an antituberculous regime at once. For 
this very good reason: investigations have 
shown that if a patient makes a good recovery 
from his pleurisy, the danger of tuberculosis de- 
veloping later is much reduced ; whereas, if the case 
be neglected or an imperfect recovery is made, 
the danger from tuberculosis is much increased. 
Pleurisy may often be so mild as to cause but a 
trifling inconvenience, but there is reason to be- 
lieve that the severity or otherwise of the pleuritic 
attack has little influence over the possible later 
development of tuberculosis. A severe attack 
of pleurisy from which a perfect recovery is made 
may turn out better in the end than a very mild 
attack, which, because of its very mildness, is 
treated with indifference, and allowed to degener- 
ate into a chronic condition. Both types may be 
tuberculous, but the radical treatment of the 
severe case may so increase the vitality of the 
system that it is able to overcome not only the 
pleurisy but annihilate the tubercle bacilli as well. 
On the other hand, a neglected mild case of pleu- 
risy may develop into a severe case of tuberculosis, 
for the simple reason that nothing is done to re- 



An Aftermath of Pleurisy 61 

tard the development of the first few scattering 
germs. 

What has oeen said applies, not only to the 
person who has a present case of pleurisy to 
battle with, but to those who have had attacks 
in the past. If such a person is now entering upon 
a period of indefinite ill health, with perhaps 
stomach symptoms, a growing muscular weakness, 
incapacity for effort, and a general feeling of 
"malaise," it might be well for him to give his 
condition immediate and serious consideration. 
I feel it my duty to point out that this mysterious 
failing of health, this unaccountable weakness, 
this growing loss of ambition and interest in life, 
may be the result of that long-forgotten attack 
of pleurisy. I do not wish to frighten any one, 
and if the present indisposition is due to natural 
causes, no one should be frightened by what has 
been said, for such an indisposition can easily be 
overcome, and should be overcome; but if simple 
measures, such as a little more care in the mode of 
life, a little more sleep, a little more wholesome 
food, and such remedies as may seem to be indi- 
cated, do not restore the former standard of health, 



62 Tuberculosis 

then a course of treatment as thorough and power- 
fully strength-restoring as the Tuberculozyne 
System of Treatment should be adopted at once. 
For at this stage, if the symptoms be tubercular, 
if tuberculosis is stealing on the sick one, the 
damage is slight, and the case offers tenfold 
greater promise of recovery than can be held out 
if time is allowed the disease in which to gain a 
firmer hold. 

The fundamental difference between true tuber- 
culous lung trouble and that of a catarrhal or 
bronchial character is that in the former the tu- 
bercle bacilli are always present. This does not 
mean that it is always possible to prove the pres- 
ence of the germ. It means that if the case is one 
of tuberculosis the bacilli must be present in the 
lungs whether demonstrable or not. The tubercle 
bacillus is a tiny little rod of which it is said fifty 
thousand could be placed side by side within the 
limits of an inch. It is of vegetable origin, in fact, 
a sort of fungus similar in character to the mould 
which gathers in damp dark places. If it were 
possible to destroy all the sputum raised by 
tuberculous people until all those people were 



An Aftermath of Pleurisy 63 

either dead or had recovered, consumption in the 
human family would probably cease to exist. As 
it is, man is the chief danger to man, and as one 
writer puts it, the most inappropriate associate 
for a consumptive is a tubercular friend. 

It is estimated that the average consumptive 
spits out from one and one-half to four and one- 
half billions of bacilli a day, and these bacilli, as 
we know, may easily be carried into the body of 
a healthy person through the medium of dust- 
laden air breathed into the lungs. 
NOTE 

The appendix mentioned in this book is printed 
in separate form, and should be preserved for 
purposes of reference. 

If lost or mislaid, write for another copy, which 
will be mailed free of charge. 

The Yonkerman Company, 
Kalamazoo, Michigan, U. S. A. 



PART II 



PROCESS OF INFECTION 

GENERAL METHODS OF DIAGNOSIS 

THE LEADING SYMPTOMS OF TUBERCULOSIS 

SUCCESSFUL TREATMENT 

BACK TO HEALTH 



Bacillus Difficult to Destroy 67 

The tubercle bacillus when deposited in warm, 
dark places, such as the corners where careless 
people usually spit, is very tenacious of life. Ex- 
periments have shown that it is still living and 
dangerous in such locations from six months to a 
year afterward. Most species of germs are easily 
destroyed, but the tubercle bacillus is not of this 
class. It resists many of our more powerful dis- 
infectants, and even heat below a hundred centi- 
grade has no effect upon it. At 15 below zero 
it is as virile as at any temperature above that and 
below 180°. Fortunately, fresh air destroys it in 
from one to five days, and bright sunlight in a 
few hours and, were it not for this fact, the 
human race might have succumbed to the ravages 
of the disease long before this. It is for these 
reasons that consumptives are instructed to 
breathe deeply and regularly, and also to keep in 
the bright sunlight as much as possible. The 
tubercle bacillus is found everywhere; they may 
be on the clothes, the skin, in the hair and within 
the nostrils of perfectly healthy individuals, when 
they may have been in contact with tuberculous 
people. 



68 Tuberculosis 

When the germs succeed in entering the body 
they do not always cause tuberculosis. They are 
now in a dark, moist place, of just the right tem- 
perature, 98 . But the human body is by no 
means defenceless against the onslaught of the 
tubercle bacillus. The mucous membrane is 
protected by countless microscopic hairs whose 
purpose it is to catch all intruders and hold them 
safely until secretion of the tissues can wash them 
away. If the germ succeeds in getting into the 
lungs its struggles are not yet over, for it has to 
escape secretions that are powerfully antiseptic. 
Even if it reach the membrane lining the air pas- 
sages, it no sooner gains a foothold than all the 
resistive power of the system is enlisted against it. 

We now come to a somewhat confusing fact, 
viz . : that the chief danger of the tubercle bacillus is 
not its presence in the lungs, but that the efforts 
of the system to overcome it may be ineffectual. 
It is the frantic but incompetent efforts of the 
body itself which cause the destruction of lung 
tissue. Let us assume a tubercle bacillus has 
gained a final resting-place on the membrane of 
one of the finer air passages. Immediately the 



Defeat of the Giant Cell 69 

system raises up around it a tiny whitish lump 
known as a miliary tubercle. The bacillus is 
imprisoned inside this little lump, and if all go 
well, if the vital force of the system is equal to 
the task, this lump will gradually harden into a 
fibrous, or musclelike tissue. 

Within this tiny lump a terrific conflict is going 
on between what the histologists call a giant cell, 
or phagocyte, and the bacillus itself. If this is to 
be a case of abortive tuberculosis, the giant cell 
digests its dinner, the germ becomes no more, and 
its fibrous, lumpy prison is gradually absorbed 
back into the blood, leaving a harmless scar behind. 

But if the bacillus has gained entry into a weak 
and debilitated body, one, let us say, in which the 
field has been prepared for it by a long-neglected 
catarrh, or even measles or typhoid, then the same 
conflict takes place, but with a very different 
result. 

It is the life-saving phagocyte that meets defeat, 
and thereupon breaks down, forming, instead of a 
healthy fibroid scar, a cheesy, mushy mass, called 
"caseous matter." The victorious bacilli increase 
in number. All around the original bacillus 



70 Tuberculosis 

other miliary tubercles spring up. In time these 
also arrive at the caseous stage of degeneration, 
and flow together as little separate drops of water 
may run into one large drop. In this way a 
giant tubercle, which may attain the size of a 
marble, or even an orange, is formed. 

Let us suppose that at this stage the patient 
takes alarm and begins a deliberate course of 
treatment. Let us also suppose that this treat- 
ment has an immediate effect for good upon the 
vitality of the system. The digestion is strength- 
ened so that the nutrition of the body as a 
whole is increased. The blood is purified and 
the nerves calmed and strengthened. Under 
such favorable circumstances a turn for the better 
may soon take place. That fibroid change may 
begin, thus shutting in within a tough muscular 
wall the millions of bacilli concentrated within 
the tubercle. If we can now raise the antiseptic 
quality, or, as it is called, the opsonic index of the 
blood to such an extent that the blood soldiers or 
phagocytes can re-enter the conflict, revitalized 
and more active than before, we may succeed in 
destroying the bacilli within the tubercle itself. 



Cavity Formation 71 

In such a case as the one just described, there 
would be, of course, no expectoration, for thepus or 
liquefied lung tissue would be held securely within 
the walls of its fibroid prison. There would be, 
most likely, a certain amount of hard, dry, hack- 
ing cough, due to the irritating presence of this 
hard lump of tissue within the delicate air pas- 
sages, and there might be, also, a more or less pro- 
nounced decline in the general health, but the 
symptoms would be of an indefinite character, 
difficult to place, even by an experienced physi- 
cian, much less the inexperienced layman. 

There being no expectoration, there could be no 
examination of the sputum, and unless night 
sweats, or a rising temperature, or fever, or that 
peculiar blocked up sensation in the chest which 
some consumptives complain of, put the patient 
on his guard, there is great likelihood such a case 
as this would be neglected until the third stage 
of the disease developed. The third stage, so 
called, is simply the escape of the cheesy mass 
within the tubercle into the open air passage, and 
the consequent establishment of a more or less 
constant expectoration. At first the sputum 



72 Tuberculosis 

will be whitish, stringy, viscid, something like 
boiled starch. As the disease progresses the 
sputum may become tinged with blood. Even- 
tually it takes on a sickly greenish, yellow appear- 
ance. Careful physical examination of the chest 
of such a patient would discover the presence of a 
cavity or a hollow in the lung substance where the 
tubercle had been before it broke down. We 
now have an angry and stubborn ulcer which 
slowly, or more rapidly, according to the character 
of the case, enlarges itself at the edges. There may 
be, of course, in some cases a number of tubercles 
in different parts of the lungs, all destined to break 
down eventually in succession or simultaneously. 
These form ulcers which gradually approach each 
other until in time they may run together, form- 
ing cavities which may be equal in size to one or 
more lobules or lobes of the lung. We then have 
a state of affairs aptly described when one says of 
a consumptive acquaintance that he has "only 
one lung left." The affected lung of such an 
individual has been literally dissolved and thrown 
out in expectoration. 

Even when matters have come to this serious 




PLATE IV. 

Illustrating the normal left lung viewed from the 
inner side. The blue and red openings are the pul- 
monary vessels through which the blood passes to 
and from the lungs to the heart. The light-colored 
opening is the bronchial or air tube. 



72 losis 

whitish, strh .mcthing like 

se progresses the 
: ;lood. Even- 
tish, yellow appear- 
: ul physical examination of the chest 
uch a patient would discover the presence of a 
vity or a hollow in the lung si o the 

ercle had been before it ' We 

e an ail -n-p* tq 
re i 
aril moii bswsiv gnul Jial Umion aril gnilBileullI 
-Iuq aril sis agninsqo bai bnfi suld srlT .abie isnni 

eak 



oJ 83886q boold srij rbirlw rlguoirll zbazav ^usnom 
baioloo-lrlgil srlT .rifiarl arrJ ol agnul arrJ morl bn/5 



.acftri Ti6 io Isirbfioid artf 21 grtirreqo 
These form ulcers which gradually approach each 
other until in time they may run together, form- 
ing cavities which may be equal in size to one or 
lobes of the lung. We 

ays of 
-umptive "only 

eh an 
cd and thrown 
out u oration. 

Eve- matters ha to this serious 



Fibroid Growths 73 

pass, all is not lost, for we now know that even 
while the tuberculous ulcer is spreading at its 
edges, the system is making strenuous efforts to 
heal it, and often succeeds in replacing the dis- 
eased tissue with a fibroid growth. 

Unfortunately, Nature, without competent help, 
seldom succeeds in overtaking the destructive 
ulceration going on at the edges of the cavity. 
The result is a consolidated lung, part of which 
is cavity and part active ulcer, part healthy lung 
tissue and the remainder hard, air-resisting 
fibroid growth, which is largely impervious to 
the breath. Consequently smoke and coal dust 
settle into this tissue, and are thereafter often 
raised in coughing as a black, sooty phlegm. 

While this ulcerating process is going on, the 
lung tissue around the numerous blood vessels is 
eaten away, leaving the veins and arteries un- 
supported. These vessels cross and recross the 
cavity like the steam pipes in a boiler room. 
Because the muscles in the blood vessels resist 
the action of the ulcerative process more success- 
fully than the lung tissue proper, most of them 
escape injury. If it were not for this it is con- 



74 Tuberculosis 

ceivable that every case of advanced tubercu- 
losis would succumb to an unquenchable hemor- 
rhage. The blood vessels, however, are not ab- 
solutely immune, and occasionally the ulcerative 
process penetrates through tiieir walls, permitting 
the blood to escape into the surrounding cavities. 
As a rule, the first hemorrhage follows some 
sort of exertion such as sudden stooping, lifting a 
weight, or climbing a flight of stairs. The exer- 
tion raises the blood pressure, that is, the blood 
stream flows with greater force through its chan- 
nels. The sudden strain comes upon the part 
weakened by the tuberculous ulcer, and a gush of 
blood occurs. Nature usually closes up the rup- 
ture in the blood vessel by means of coagulation, 
which forms a clot and stops the flow of blood. 
But if a large artery or vein has been attacked 
and a considerable portion of its wall has beea 
destroyed, the resulting breach may be too large 
for Nature's clot to close, and the result will be what 
is known as a fatal hemorrhage. Fortunately, 
such accidents as this are rare. As a rule hemor- 
rhages are slight in quantity, seldom exceeding 
one or two ounces. 



All Is Not Lost 75 

Thousands of tuberculous people will not admit, 
many do not even suspect, that they have 
tuberculosis until the initial hemorrhage takes 
place. 

Then they are anxious enough for treatment, 
but as all are now well aware, inestimably valu- 
able weeks or months of time have been lost, and 
the case is no longer an incipient attack, but a 
well-developed example of tubercularization. 

Still, there is hope, even after a hemorrhage has 
occurred. If only the nutrition can be increased ; 
if we can give the patient a healthy, hearty ap- 
petite; induce sound and restful sleep; prevent 
him from worrying; fill his lungs day and night 
with good fresh air; bathe his body in the life- 
saving sunlight; and fortify the blood stream 
against the toxins of the disease, by the best -indi- 
cated remedies, we may still hope for the recovery, 
even at this late stage. 

Many of the reports in the accompanying ap- 
pendix are from cases that were successfully 
treated after hemorrhage had occurred. 

In order to encourage the vital forces of the 
body as just described, an essential of the success- 



76 Tuberculosis 

ful treatment is that it shall be able to overcome 
the poisons of the bacilli circulating in the blood. 
Strange as it may seem, it is not the lung ulcer 
which causes the weakness, the muscular in- 
ability, the decline in health. It is the powerful 
toxins, or poisons, thrown off by the bacilli which 
create this effect. These toxins profoundly dis- 
turb the nutrition. If they are not antagonized 
and overcome, they will rob the body of its vital 
strength, and then the ulcer in the lung will have a 
free hand to destroy its host. 

Dr. Brown says that if we produce immunity to 
these toxins, if we supply the system with an 
antidote, we could in many instances, perhaps 
all, overcome tuberculosis with as little effort 
as we now throw off an unimportant ailment. 

This may be the explanation of the remarkable 
recoveries accomplished by the Tuberculozyne 
Treatment. 

It is most unfortunate that many who are in a 
more or less serious state of tubercular infection 
continue to neglect their condition. 

No doubt some of these people do not believe 
they have tuberculosis, for the reason that they 



Sputum Examinations 77 

have had their sputum examined, and no bacilli 
were found. The detection of bacilli in the sputum 
of a patient settles all doubts at once as to the 
nature of the disease. Many people are aware of 
this fact, and have been led thereby into what 
must be considered a serious error. They have 
jumped to the opposite conclusion that if no 
bacilli are found in their sputum they are not 
tuberculous. But this does not follow by any 
means! The bacilli are present in the sputa of 
most cases, but they may be, and often are, 
absent, even in advanced cases. 

We have just explained why bacilli would be 
absent from the sputum of a person in whom the 
tubercle was undergoing' a fibroid change. It is 
also absent occasionally in the sputum of acute 
miliary tuberculosis, or galloping consumption, 
which, as every one knows, is almost invariably 
fatal. It is also extremely likely to be absent 
from the sputum of those mild beginning cases, 
which of all cases of tuberculosis are the ones 
which should be put under treatment immediately, 
for they have, it is everywhere acknowledged, 
splendid, almost certain, promise of recovery. 



78 Tuberculosis 

It is advisable to make a careful examination of 
the sputum in all cases where tuberculosis is sus- 
pected, for if we find it to contain bacilli, that 
fact settles all doubt as to the nature of the dis- 
ease. It is tuberculosis! 

But though we use every scientific means at 
our disposal to determine the true character of 
the sputum, it must be borne in mind that it is by 
no means certain we would always find bacilli, 
even in the sputum of the actual consumptive. 
I have already explained why the bacilli may 
succeed in escaping detection. 

Recent investigations, however, have demon- 
strated the almost unfailing presence of albumin 
in sputum containing bacilli, and since it is rarely 
if ever present in simple cases of pulmonary (lung) 
irritation or bronchitis, the absence of bacilli in 
the sputum with no albumin may be taken as a 
reasonably safe diagnosis of non-tuberculosis. 
However, when the microscopic examination 
shows bacilli to be absent but the chemical test 
discovers albumin, with perhaps some other 
symptoms, it is not safe to pronounce the case 
non-tuberculous. In all such cases a thorough 



Methods of Diagnosis 79 

course of treatment is the only safe course to 
pursue. 

There is, however, another view point about 
sputum examinations of which note should be 
taken. If bacilli are found, the announcement 
Is liable to cause much depression in the mind of 
the patient. As a matter of fact, however, a 
case of no detectable bacilli in the sputum may be 
t>ne in which the bacilli are quite numerous. The 
patient should be made to understand that the 
disease is by no means beyond hope of cure simply 
because of the presence of bacilli. 

The number of bacilli present are supposed to 
liave some relation to the activity of the disease, 
but a case is not an unfavorable one though 
bacilli are numerous in the sputum, provided 
the constitutional state of the patient is good. 
On the other hand, there may be few or no 
bacilli present in the sputum of a patient 
whose constitutional condition gives occasion for 
alarm. 

Dr. Minor says: "Absolute certainty can only 
be obtained by discovery of tubercle bacilli in the 
sputum. No one, therefore, should deprive his 



80 Tuberculosis 

patient of the advantages of early treatment be- 
cause he cannot demonstrate the germ." 

In the absence of bacilli from the sputum, how 
are we to determine whether a case is tuberculous 
or not? There are many and varied ways of 
arriving at a decision, viz. : by inquiry into the 
history, the general appearance of the patient, 
and the character of his symptoms. Personal 
history throws valuable light on a case, and taken 
in connection with the symptoms present, may 
afford strong presumptive evidence that the case 
is tubercular. Please understand that what fol- 
lows is information of a general, and not of a 
particular character. It should not be miscon- 
strued or lightly imputed to any particular case 
unless the evidence is preponderant. We voice 
this warning in order to prevent any misconcep- 
tion as to his condition in the mind of any reader. 
It is very essential that one who is tuberculous 
should be made aware of that fact in order that 
he may have reason for beginning treatment at 
once, but it is equally essential that the non-tuber- 
cular person shall not get the impression he has 
the disease and so develop that half hysterical 



Importance of Family History 8 1 

condition known as phthisiophobia (excessive 
fear). With this understanding well in mind let 
us see what the history of the suspected case 
amounts to. 

We should inquire at once as to the character 
of the occupation. Has the patient been engaged 
in a dusty, hot, damp or cramping occupation? 
Is it possible that where he or she works the air 
is foul and unrenewed for considerable periods? 
Does he work with the upper part of the body in 
a contracted or distorted condition, as, for in- 
stance, is the case with sewing machine operators, 
bookkeepers, etc.? 

Family history should be inquired into next. 
Have any of the family, or near relatives, suffered 
with consumption? If so, who, how long ago, 
and especially, where? The point of the last 
question is, that if the consumptive relative lived 
in the same house or was in frequent or close 
association with the patient, this fact has a certain 
value, for, as you now know, under such circum- 
stances it would be comparatively easy for the 
germ to pass from the one individual to the other. 
A healthy person who is never exposed to the 



82 Tuberculosis 

germs can not contract tuberculosis, and con- 
trariwise, the more frequently they are brought 
in contact with the disease, the greater proba- 
bility there is of infection. As the theory of 
heredity is now practically abandoned, it may 
seem strange to place any value on the family 
history at all. But while direct transmission of 
the germ is now considered impossible, it is very 
generally believed that a tendency to the disease 
can be transmitted by tuberculous parents to 
their children. 

If the patient be the offspring or kin of tuber- 
culous people, and has lived or associated with 
them, and also is engaged in a confining or un- 
healthy occupation, you will see at once that the 
combination of circumstances has its weight in 
determining whether or not the developing lung 
trouble be tubercular. 

Careful inquiry should also be made as to what 
diseases, if any, have preceded the present lung 
disorder. The ailments most often followed by 
tuberculosis are pleurisy, measles, influenza, 
whooping cough, typhoid, syphilis and dyspepsia. 
We have already explained how pleurisy, in- 



Imitative Tuberculosis 83 

fluenza, bronchitis and catarrh may be, not what 
they are supposed, but a mild beginning of con- 
sumption itself. This probability, therefore, gives 
a particular importance to these antedating dis- 
eases. In the same way diabetes, dyspepsia 
and anemia may be either predisposing or early 
manifestations of tuberculosis. Tonsilitis par- 
ticularly and throat troubles generally should be 
inquired about. We should also know whether 
or not rheumatism and nervousness have been or 
are present. The reason for this is that tubercu- 
losis is an imitative disease and may show its 
worst effects, not in the lungs or the air passages, 
where the symptoms may be very trifling, but in 
the joints, nerves and blood. 

Wilkinson says: "We learn often enough 
that throat symptoms, blood disturbances, diges- 
tive troubles, ovarian troubles, and nervous symp- 
toms without any lung symptoms at all, may give 
the first clue to pulmonary (lung) disease." 

Such masked onsets of the disease are not un- 
familiar, by any means. We have all seen exam- 
ples of young people, particularly growing girls, 
falling into what is called a decline. Such a con- 



84 Tuberculosis 

dition may be the result of the action of the disease 
on the blood. Girls so affected are easily tired, 
easily excited, grow gradually thinner, have a poor 
appetite, weak heart, increased pulse, shortness 
of breath, sharp temper, flush readily, especially 
after meals, and are considerably annoyed by 
excessive perspiration. But the lung symptoms 
are frequently so mild as to escape notice. 

When the disease assumes a rheumatic form it 
is said to be due to a saturation of the system by 
the toxins or poisons generated by the bacilli. 
This poison, besides causing a more or less pro- 
found feeling of ill health, acts identically as any 
other rheumatic poison would act. It produces 
pain in the joints, especially the hip and knee. 
Cramps in the muscles, especially that of the calf 
of the leg, aching of the thumb, little finger and 
heel, and possibly a dragging, boring, lancinating 
backache. 

In the nervous type of tuberculosis we must be 
exceedingly cautious not to give ( the nervous 
symptoms an ounce more weight than they are 
entitled to. Lindsay says, "that a combination 
of languor, debility, etc." requires cautious inter- 



Nervous Symptoms in Tuberculosis 85 

pretation, and that, "in the absence of cough, 
wasting, temperature changes, fast pulse or hemor- 
rhage, the combination does not give strong 
foundations for suspicion." What, then, is the 
cause of the nervous debility? Is it apparently 
uncaused? Is a previously strong and hearty 
individual growing more and more nervous, irri- 
table and erratic? If so, can we attribute this 
condition to worry, overstudy, anxiety, excessive 
nursing, or disappointment? In that case, and 
other symptoms do not point toward consumption, 
we are hardly justified in giving the nervous 
symptoms consideration. But if the nervous 
symptoms are mysterious, unaccountable, un- 
explainable; if they seem to have no real cause; 
then they begin to be more significant, for it is a 
peculiar fact that the nervous symptoms of tuber- 
culosis seem to be uncaused, whereas, there is 
usually good and sufficient reason for the nervous- 
ness of general debility. 

The nervous type of tuberculosis is associated 
with a bright intellect. Such patients are very 
responsive to impulses. It is among this class 
we find the tuberculous musician, author and pro- 



86 Tuberculosis 

fessional man. The disease usually puts its mark 
on its victim, and this mark is more noticeable in 
this class of capable citizens than in any other type. 
The eye of such patients is usually bright and 
vivacious, — too bright, in fact; the skin is moist 
and soft and delicate; the color is high, too vivid, 
indeed ; the movements are quick, the attitude is 
alert and attentive; but one gets the impression, 
somehow, that there is a quick limit to the endur- 
ance. This is the fact. Such patients exhibit 
remarkable energy and acuteness, but they soon 
tire and recover less quickly than would a normal 
healthy person under similar circumstances. 

The physical appearance of a patient often 
affords important evidence as to the character of 
his lung symptom. We should observe the chest 
carefully. Is the clavicle or collar bone, on either 
or both sides, normal? Does it seem to slant 
downward? Is there a slope to one of the 
shoulders, so that it hangs below the level of its 
fellow? Any depressions should be carefully 
observed. Depressions or hollows in tuberculosis 
usually make their appearance around the base 
of the neck. If a hollow in this vicinity seems to 



Signs of Debility 87 

be growing deeper, the fact should not be over- 
looked, for hollows in this neighborhood may mean 
more than mere loss of flesh ; they may be the re- 
sult of the shrinking away of the tuberculous lung. 

The patient should be instructed to breathe 
deeply in order to show whether the rise and fall 
of the chest is natural or not. In bronchitis, as 
already mentioned, the expansion of the chest is 
usually unchanged, whereas in tuberculosis the 
rise of the chest is often noticeably interfered with. 
The back of a pronounced tuberculous person is 
characteristic. The shoulder blade on the affected 
side may be lower than the other. Both shoulder 
blades may seem to be pushed outward, giving the 
impression of a wing. In the more serious cases 
the spine may be curved, with its concave side 
facing the affected lung. 

In very bad cases, the region of the stomach 
may be depressed. A deep, melancholy- looking 
depression immediately below the breast bone 
meets the eye. 

We should next direct our attention to the eyes, 
hair, finger-tips, nails, teeth, and gums. If the 
vitality be on the decline, the hair will probably 



88 Tuberculosis 

seem rank and void. The finger-tips will be 
bloodless or purplish, the nails ridged, the teeth 
tender and brittle, and the gums pale. If there 
is pronounced indigestion the tongue also will be 
affected, raw looking, indented by the teeth, and 
very flabby. 

It must not be forgotten that bronchitis may 
also affect the appearance of the chest. Bron- 
chitis, in ulcerated and advanced stages, is a de- 
bilitating disease, and may so seriously affect the 
general health as to cause a decline in flesh, when 
suspicious-looking hollows may form between the 
ribs and elsewhere on the chest and back. It 
must also be borne in mind that bronchitis causes 
hemorrhage, night sweats and a high temperature 
in nervous and debilitated persons, so that even 
with such strong and presumptive evidence of 
tuberculosis as such appearances would appear to 
be, there is a possibility that the latter disease is 
not present. Even so, it would not justify a per- 
son in neglecting treatment, for whether the dis- 
ease is bronchitis or tuberculosis, only benefit can 
result from proper treatment, while neglect and 
delay may result in serious consequences. 




PLATE V. 

lung from case of miliary tubera 
showing inflammation of surface and general en- 
largement of the entire lung with lines indicating the 
several lobes obliterated. 




88 Tuberculosis 

see and void. The finger-tips will be 

purplish, the nails ridged, the teeth 
d the gums pale. If there 
the tongue also will be 
he teeth, and 
►by. 
nust not be forgot i iritis may 

oct the appearance of Bron- 

n ulcerated and ad I de- 

bilitating disease, and the 

health as-\& slJTAJS 
Mzo\uDi^6ui yifiilirn ho ozbo moil gnul JrlgiH ' the 
-as Ifiiansg bnfi sofihue \o notifimmfiftni gniworfe 
aril gndBoibni zsnil rlliw gnul aiilna aHl }o Jnam^gifil 

•bajgisiildo eadoi Ibisvsz 

t nage, nignt sweats ana a nigii temper cilulL/ 

ous and debilitated persons, so that even 
wit strong and presumptive evidence of 

tub as such appearances would appear to 

•ssibility that the latter disease is 
not i not justify a per- 

son tether the dis- 

eae ly benefit can 

result I while neglect and 

delay may result in serious consequences. 



Instrumental Examinations 89 

To the above general survey of the physical 
characteristics of his patient, the examining 
physician would add percussion and auscultation. 
To the trained ear, the diseased chest gives forth 
certain characteristic sounds. It is to these the 
physician listens through his stethoscope when 
he taps the chest with his fingers. Liquefied lung, 
pus cavities, etc., modify the sounds in the lung 
when the breath is drawn in. The art of inter- 
preting these sounds is called auscultation. 

If it be possible to make a direct oral examina- 
tion of this character, well and good. It may lead 
to a strong suspicion that tuberculosis is present, 
but it does not always afford positive evidence. 
Somehow or another, the average man has gotten 
the impression that if a physician applies the 
stethoscope to his chest, taps him a few times here 
and there, and then assures him he is or he is not 
tuberculous, as the case may be, that settles it 
absolutely. The great Strumpell says : "He who 
lays too great stress on the uncertain results of per- 
cussion will often make a false diagnosis." So 
much for percussion. Fowler and Goodlee wrote 
in their monumental work on tuberculosis : "The 



90 Tuberculosis 

observer must beware of relying on auscultation, 
with its many fallacies. A definite opinion should 
be given rarely in doubtful cases, unless the record 
of the morning and evening temperature for at 
least a week is available. Consequently, we re- 
frain from absolute diagnosis because same is ex- 
ceedingly precarious." 

The reason for this non-committal attitude 
toward auscultation and percussion, on the part 
of the leaders of the profession, is that very often 
the palpable symptoms of a case and the physical 
signs as developed by auscultation and percus- 
sion, conflict. In other words, one-half of the 
evidence is in favor of, and the equally important 
remaining half is opposed to, a diagnosis of tuber- 
culosis. This situation undoubtedly influenced 
Lindsay to write down this rule of guidance : 

"Where the physical signs and the symptoms 

conflict ... IT IS SAFER TO TRUST TO SYMPTOMS." 

Only a competent medical man can perform per- 
cussion and auscultation, but any ordinarily intel- 
ligent human being is capable of estimating the 
significance or lack of significance of his symptoms. 

In many cases of developing tuberculosis, the 



Dyspepsia in Tuberculosis 91 

first symptoms are those of indigestion. There is 
nothing about these symptoms to distinguish them 
from those of ordinary dyspeptics ; consequently, 
unless they are associated with other signs of lung 
trouble, particularly with cough, fever, expec- 
toration, etc., they have little diagnostic value. 
There will be discomfort after eating, a feeling of 
fullness and weight in the abdomen, belching, 
over-acidity of the stomach, tenderness in the 
pit of the stomach, heartburn and loss of appetite. 
Von Behring says that this loss of appetite is a 
pre -tuberculous indication. In some cases the 
appetite is not exactly lost, but it becomes fickle. 
At times the patient can eat nothing, and on other 
occasions he has a simply tremendous capacity 
for food. He is apt to develop notions regarding 
delicacies, or peculiar articles of diet, as illustrated 
by the young girl in a decline whose preference 
in the way of food is pickles. A more significant 
symptom than any of the foregoing is vomiting, 
and especially vomiting after meals. If these 
vomiting spells are preceded by coughing, then 
they become even more important still, for this 
is really a leading symptom of incipient tuber- 



92 Tuberculosis 

culosis. Diarrhea, of which there are two types 
in tuberculosis, may be added to the above dys- 
peptic symptoms, giving the latter an added grav- 
ity. One type of diarrhea is an irregular, soft, 
shattered motion, accompanied by a furred tongue, 
foul breath, and continuous uneasiness in the pit 
of the stomach. Or this complication may show 
itself as a painful bloody motion, accompanied by 
deep pain on pressure of the abdomen. 

Another variety of the same type of diarrhea, 
due to degeneration of the intestines themselves, 
presents itself as a constant, dribbling, painless 
watery flux. In all these cases the tongue will be 
unnatural, either raw looking, abnormally clean, 
or red, or large and flabby, and showing the in- 
dentations of the teeth. The latter type of 
tongue is present when the bowels are ulcerated. 

It is very important, indeed, to determine 
whether a suspicious dyspepsia is of tuberculous 
character or not. Lindsay writes: "A not incon- 
siderable proportion of such cases become tuber- 
cular." If tuberculosis is suspected as the cause 
of the indigestion therefore, particular and minute 
inquiries should be made as to whether or not 



When Fats Are Refused 93 

there are other symptoms of tuberculosis present, 
as, for instance, cough, fever, wasting, night 
sweats, hemorrhage. 

In the more advanced cases of tuberculosis the 
dyspeptic symptoms increase in severity. There 
may develop an absolute loss of appetite, con- 
tinual stomach pains, with a disgust for even the 
most tempting food. A growing inability to eat 
fatty articles of diet may develop. This is an 
unfortunate symptom indeed, for it is on fats and 
oils and similar foods that the expert physician 
largely depends to increase the energy and strength 
of his patient. 

Without a doubt, part of the credit for the 
splendid results secured by means of the Tuber- 
culozyne System of Treatment is due to the favor- 
able effect it has upon the digestive organs. 
Dietary instructions and tonic treatment of the 
digestive organs form a very important part of 
this treatment. Therefore, if a dyspeptic, not 
tuberculous, but suspecting himself to be so, de- 
cides to take a course of the Tuberculozyne 
Treatment, the results, in any event, should 
justify his decision. 



94 Tuberculosis 

The nervous symptoms of tuberculosis are often 
entirely due to digestive disturbances caused by 
the disease. They may be quite numerous, but 
are not, as previously explained, characteristic. 
One of the most common affections of the tuber- 
culous nervous person is headache. It is the 
same kind of dull ache in the temples, forehead 
or top of the head that is familiar to dyspeptics 
everywhere. Of course, in the more severe types 
of the disease, when the poisons of the bacilli are 
generally distributed throughout the system, the 
nervous symptoms are correspondingly more se- 
vere. We may then find rigor, intractable and 
distracting sleeplessness; an uncontrollable rest- 
lessness which will not permit the patient to rest 
in any position is sometimes seen; convulsions 
may occur; loss of memory; a persistent and ex- 
hausting hiccough, and photophobia, which is a 
severe pain in the eye caused by the action of 
light on the retina. 

The effect of tuberculosis on the skin is an in- 
definite and unimportant sign of the disease. 
Owing to the debility which the tuberculosis may 
cause, there are cases in which the tuberculous 



The Complexion of Degeneration 95 

person develops serious skin diseases. Lupus 
vulgaris is a serious skin disease of tuberculous 
nature. 

A delicate transparent skin is characteristic of 
the sanguine or fine grained type of consumptive. 
Some authorities believe that the blond, or red 
haired person, is more apt to contract tuberculosis 
than the dark-haired, coarse-skinned type. It 
is impossible to present any statistics on this 
point, the statement being based merely on ob- 
servation of a limited number of tuberculous 
people. The complexion is also quite character- 
istic in some tubercular individuals. The end of 
the nose may be white and waxy, the color high, 
and especially brilliant on the side of the affected 
lung. The appearance of people so marked is 
striking, for this vivid splotch of feverish color 
may be, and often is, surrounded by a deathly 
pallor. It is worthy of note that when the fore- 
going signs are present, the injury to the lung 
is apt to be considerable. 

As a general rule the onset of tuberculosis is 
insidious. There comes a gradual loss of vitality. 
The body loses nourishment. No special trouble 



96 Tuberculosis 

is discoverable, but there is an indescribable feel- 
ing of languor, lassitude and ill health. There 
develops, sooner or later, a trifling but neverthe- 
less abnormal tendency to cough, and a trifling 
but also unnatural tendency to expectorate some- 
thing — apparently phlegm — which is lodged in the 
back of the throat and slightly interferes with the 
voice so that the throat has to be cleared before 
speaking. The patient almost invariably over- 
looks these trifling symptoms, and even after an 
initial hemorrhage has driven him post-haste to 
the doctor, he will often answer the latter 's in- 
quiry as to cough and expectoration with an 
emphatic denial. 

Unfortunately, such a case is no longer in the 
earliest stage, as is proved by the hemorrhage. 
In other words, the chances for recovery have 
been lessened by the previous few weeks or months 
of neglect. This is so vital a matter to the wel- 
fare of the tuberculous patient that it prompted 
Dr. Minor to write the following extract: "It 
cannot be too insistently noted, that every patient 
complaining of loss of vitality, nourishment, color, 
etc., which cannot be satisfactorily and clearly 



Significance of Lung Pains 97 

accounted for, should be regarded as possibly 
tuberculous, and carefully examined for signs 
of that disease." 

Pain is a symptom of tuberculosis, of frequent 
occurrence, but of little value as a help to diag- 
nosis. Strange to say, a pain in the lungs, even 
though slight, and of no significance, will often 
cause more distress of mind than other far more 
important symptoms of the disease. A person 
will suddenly develop a sort of dull aching in the 
upper part of his chest, and it will immediately 
occur to him that he has contracted lung trouble. 
His apprehension is increased if, as often happens, 
the lung feels bound down and choked up. But 
such a pain as this may be due to intercostal 
rheumatism, to neuralgia, or to dyspepsia, so 
one must not look upon a pain in the chest as 
positively indicative of lung disease unless there 
are other important symptoms present. When 
the lung is painful, the distress is usually located 
on the side of the diseased lung. This would seem 
so obvious to the average person as to be un- 
worthy of mention. The pain is not, however, 
invariably on the side of the affected lung: it 



98 Tuberculosis 

may, indeed, by irritation of the sympathetic 
nervous system, appear as a pain at the base of 
the neck, or even show itself at some point 
along the malar or jaw bone. A dull, heavy ache 
in the lungs may be due to a crowded condition, 
but a sharp pain indicates a pleuritic irritation. 

As a rule, an examining physician will pay 
little attention to the pain, giving it merely pass- 
ing notice, but in the absence of other definite 
symptoms presented by a person who shows a 
gradual loss of strength and energy, it assumes a 
certain importance. There are cases in which it 
has been practically the only specific sign of the 
disease. Wilkinson says: "There may be no 
pulmonary symptoms even in the relatively iate 
stages of the disease. In one case there was ex- 
tensive consolidation of the right lung, especially 
of the whole upper lobe, with no cough and no 
sputum." 

We will assume that the above warning has 
been given attention. The patient presents him- 
self at the doctor's office for treatment. We will 
most likely see before us a typical case, such as 
that described by Lindsay: 



A Picture of Tuberculosis 99 

The patient is a youth. Says he is well. At 
first denies all symptoms, but finally admits a 
slight cough in the early morning. He spits and 
hawks and clears his throat a little, while dressing 
for breakfast. He is not sure that he has always 
had to perform this unpleasant duty, because he 
never really gave the matter much attention, but 
is inclined to think that it is a recent development. 
Yes, he has seen traces of blood, but always sup- 
posed it was caused by the irritation of the tooth- 
brush. He has lost weight recently, but not any- 
thing to speak of, and is quite sure that this loss 
was caused by overtraining, etc. About twelve 
o'clock at night a hot flush comes over him occa- 
sionally, and on at least two or three occasions he 
has found his neck and the upper part of his back 
and chest damp with perspiration. A physical 
examination shows a rather flat chest with poor 
expansion. The body of the patient is only in- 
differently nurtured. The hands are hot and 
moist, and the intelligence alert — even pert, but 
the bodily strength and endurance is below the 
average for a youth of his age and build. 

The above is a picture of a person we all know. 



ioo Tuberculosis 

Tell him he has consumption and he will laugh 
in your face. But he is just the type that needs 
treatment. 

The most constant of all symptoms of tuber- 
culosis is the cough. The first cough noted is 
usually one erroneously described by the patient 
as a stomach cough. He insists that it is either 
that or of nervous origin. It is very difficult to 
persuade him otherwise. This is, to say the least, 
unfortunate. There is of course no stomach 
cough, but is often so called because apparently 
being induced by an irritated stomach. 

It must not be forgotten that a morning cough 
is common in slight bronchitis. A more or less 
persistent cough is caused by smoking. When a 
cough is being considered as a possible symptom 
of tuberculosis, other characteristic signs of that 
disease should be looked for : otherwise it is easy 
to make a mistake. If it be a cough that comes 
on after meals, it may be and quite likely is tuber- 
culous, for such a cough is "characteristic of 
pulmonary tuberculosis." 

If the cough is due to a tickling sensation in the 
throat, and amounts to a definite effort to clear 



Possible Cause of "Ahem-ing" 101 

the air passages of an apparent obstruction, it is, 
in all probability, a sign of debility of the larynx. 
Chiari says: "All tuberculous people have a pallor 
and poor resisting power of the upper respiratory 
tract and especially of the larynx. Therefore, 
they have a tendency to chronic and also acute 
recurring catarrh." 

Such people would consider themselves suf- 
ferers with catarrh, but it will be observed that he 
says: "Tuberculous people" have such a catarrh; 
therefore, the catarrhal symptoms and the catar- 
rhal cough just described may not be the cause, 
but the direct effect, of the debilitating action of 
the possibly unsuspected tuberculous lung below. 
A person in this condition often "ahems" before 
speaking, and occasionally his or her voice will 
break in the middle of a sentence. Lindsay 
thinks it wise to consider such cases as strongly 
suspicious of tuberculosis, but not always even 
if such cough has lasted for a considerable time. 

The authorities are agreed that there is good 
reason for haste in adopting treatment when the 
throat shows signs of weakening, for according to 
statistics one-third of all consumptives develop 



102 Tuberculosis 

tuberculosis of the larynx or the vocal cords. 
The weakened throat tissues are, of course, in- 
fected by some of the innumerable bacilli the 
patient raises from the diseased lung. Some- 
times a threatened throat infection can be antic- 
ipated. It will be noticed that the voice is 
growing hoarser, especially in bad weather. 
Under such circumstances, if the case can be con- 
sidered tuberculous at all, treatment should be 
begun at once, for throat tuberculosis is a very 
serious affair. Early lesions are readily curable, 
and advanced ones not infrequently so, but a bad 
case, which refuses to respond to treatment, is 
one of the most terrible afflictions to which we are 
exposed. It causes a never-ending agonizing 
pain, destroys the rest and appetite, and quickly 
exhausts the vitality. 

The sounds caused by the tuberculous cough 
are so varied as to mean little or nothing in diag- 
nosis. Sometimes the sound is sharp, hard; 
again it is ringing, vibrant. In some cases it 
reminds us of a bark; or it may be soft, moist and 
low. A hollow cough usually means cavities are 
present, and a paroxysmal cough, that the tu- 



A Boon to Older People 103 

bercle is discharging a tough, viscid secretion 
which the respiratory muscles find it difficult to 
remove from the air passages. 

As a rule the tuberculous cough is worse in the 
morning and evening than it is during the day. 
At first the patient is not bothered after he gets to 
bed. Later on he will find occasion to arise per- 
haps once or twice in order to clear his throat. 
Early cases do not cough much during the day 
time, but as the disease progresses, this symptom 
begins to show during the waking hours, especially 
after meals or following some unusual excitement. 
Changes of temperature and drafts of cold air also 
cause fits of coughing. This is especially true in 
the cases of old people, who are consequently de- 
barred from adopting the more radical methods of 
open air treatment. It is in such cases as these 
that the Tuberculozyne System of Treatment may 
be said to be a boon, for as an examination of the 
reports in the appendix will show, a large number 
of people of advanced age have used it with 
splendid results. 

The early cough of the consumptive, like the 
cough of the bronchitic, often entirely disappears 



104 Tuberculosis 

in the warm weather. This produces a false 
sense of security, which should be guarded against, 
if it prompts one to drop all treatment. When 
once the disease has gotten a good foothold, how- 
ever, and the cough is established, warm weather 
has less effect upon it, and this symptom usually 
continues. 

This seems to me to be a very appropriate place 
in which to make certain observations regarding 
cough. This particular point will be dwelt upon 
again when we come to the chapter on treatment, 
but it is so important that it will bear repeti- 
tion. 

A tuberculous cough may be so severe as to 
seriously interfere with the general welfare of the 
patient. Such a cough better be quieted, but is 
largely possible by the patient's own will power. 
Cough is apt to become a habit with the consump- 
tive person. He may cough eight times in ten 
unnecessarily. This simply irritates the throat, 
reduces its resistive power, encourages throat 
lesion, and induces the nerves to bring on the 
cough spasm with the slightest provocation. On 
the other hand, no matter how frequent a cough 




PLATE VI. 

Tuberculous sputum stained by Gabbett's method. 
Tubercle bacilli seen as red rods; all else stained 
blue. The bacilli are magnified about 3,000 times. 




104 Tuberculosis 

in the warm Tliis produces a false 

! be guarded against, 
if it prompts oi treatment. When 

once the disease has . od foothold, how- 

ever, and the cough , warm weather 

lias less effect upon it, ai mptom usually 

continues. 

This seems to 
in which to m. :.rding 

This particular point will be dwelt upon 
.IV 3TAJfipter on treatment, 
borhsm e'iteddaO yd bsnisfc mu1uq 2 auoluraduj 
bftiiifife sab Us ;aboi bai 8B n 9M iIIwBd abwdul 
. 83 fflil 000, £ luodfi b^BinsBm 9iB illpfid aill .auW 
seriously interfere with the general welfare of the 
patient. Such a cough better be quieted, but is 
largely possible by the patient's own will power. 
Cough is apt to become a habit with the consump- 
tion. He may cough eight times in ten 
unnecessarily. This simply irritates the throat, 
reduces its resistive power, encourages throat 
lesion, and induces the nerves to bring on the 
cough spasm with the slightest provocation. On 
the other hand, no matter how frequent a cough 



\ 



// 




.-■? 



y 



\ 



i> 




An Absurd Notion 105 

may be, if it is easy and useful (raises sputum), 
it should not be interfered with. 

A thorough system of home treatment will in- 
clude suggestions as to the management of the 
cough, which is of great value to every sufferer 
with lung trouble. The Tuberculozyne Treat- 
ment, as shown by the reports of patients in the 
appendix, has a most favorable effect upon this 
very distressing symptom, and it produces this 
effect not through any habit forming drugs or 
narcotics, which are never used. The quick 
improvement in the cough symptoms mentioned 
by patients is attributed entirely to the healing 
power of the treatment itself. 

The foregoing remarks should be given par- 
ticular attention, especially by readers who 
through misinformation may have gotten the 
idea that cough causes consumption. This idea 
has been fostered and improved upon by some 
people with cough medicines to sell, but if you 
have read these pages with only average care, 
you by this time know that there positively can- 
not be a cough unless there is inflammatory or 
other disease of the respiratory organs. 



106 Tuberculosis 

Furthermore, the patient should abandon the 
idea that because his cough has stopped, his lung 
trouble is necessarily on the mend. Sometimes 
to stop a cough, especially one which is raising 
sputum, is most harmful, for cough is Nature's 
method of getting rid of the poisonous secretion 
that has gathered in the air passages. The cure 
of consumption, when accomplished, comes about 
through the healing of the ulcerated tissue, and 
not by keeping the sputum in the body, where it 
can have no effect except an injurious one. To 
stop a cough by means of cough medicines, 
especially in a patient in whom other symptoms 
of consumption are not prominent, gives him a 
false sense of security, during the continuance 
of which, in the absence of a real constitution- 
building treatment, the disease may make such 
inroads as to seriously jeopardize his chances of 
recovery. 

Sputum, or as it is commonly called, the phlegm , 
coughed up and discharged by a person with 
lung trouble, has great weight in determining 
whether the latter is of a tuberculous character 
or not. Sometimes there is no expectoration 



Swallowing Sputum Dangerous 107 

(spitting) in the early stages of the disease, but 
this is a comparatively rare occurrence. Eighty- 
three out of every one hundred patients in the 
first stages of tuberculosis expectorate more or 
less. In some the quantity is almost nothing, 
being simply a trifling amount of whitish, glairy 
mucus. The amount of sputum being produced 
is also obscured by the common custom of swal- 
lowing. Women are particular offenders in 
this respect, owing to their unwillingness to ex- 
pectorate. Some patients refuse to spit. This 
practice is a very dangerous one, and there is no 
doubt when it is discontinued, the prospects of 
that particular patient immediately improve. 

Tuberculosis is a self-inoculable disease, that is 
to say, a tuberculous person can infect another 
part of his body with bacilli from his lungs. Con- 
sequently, to swallow the sputum, which may 
contain large quantities of bacilli, is to run 
serious danger of causing tuberculosis in some part 
of the digestive organs. This is why, in many 
cases, we have stomach trouble associated with 
lung tuberculosis. The swallowed bacilli are 
often the direct cause of the diarrhoea, which in 



108 Tuberculosis 

many cases, by causing debility of the system, 
very materially, discounts the patient's chances 
of recovery. 

Bacilli may also pass from the intestines into 
the general circulation, and eventually reach the 
brain, causing meningitis, a swiftly fatal form of 
tuberculosis. 

At first the sputum of tuberculosis is a sticky,' 
shiny, stringy mass, which may contain certain 
dark points. This color may be due to carbon 
previously inhaled in the form of smoke, but it 
may also be caused by particles of degenerated 
lung tissue. 

In early cases the sputum may contain also 
little rounded pellets, which look like boiled sago. 
As the disease progresses the sputum grows 
thicker, becomes more yellow, and while it may 
float in water, sends down long streamers from 
its under surface. Later on, when the sputum 
has become still more abundant and of a dis- 
agreeable greenish-yellow color, it sinks heavily 
in water, and collects on the bottom of the vessel 
used, in the form of a disgusting foul-smelling 
deposit. If examined closely, roundish coin -like 



Conflicting Signs 109 

bodies may be detected in this deposit, indicating 
positively, even in the absence of all other tuber- 
culous symptoms, that the lung is seriously dis- 
eased. These coin -like bodies are considered by 
all the authorities as very good evidence of the 
existence of a lung cavity. 

At first tuberculous sputum has no odor, but it 
gradually develops a slightly sickly smell, and 
later on in the development of the disease may 
become extremely offensive. In the earlier stages, 
also, the quantity of the sputum expelled is very 
slight, as already noted. It gradually increases 
in amount, however, as the disease progresses, 
and some advanced cases will expectorate one or 
more pints of pus and phlegm during the twenty- 
four hours. 

The ordinary person would suppose that the 
large amount and increased offensiveness of the 
sputum must necessarily mean that the case is 
progressing unfavorably. For this reason, as in 
the similar case of cough, many lung sufferers 
suppose that if they stop the raising of the pus by 
means of medicines, they are thereby improving 
their condition. It does not follow, however, 



1 10 Tuberculosis 

because the sputum is considerable and possibly 
increasing, that the case is not making favorable 
progress. There are many instances on record 
in which considerable expectoration was present 
almost up to the time of recovery. On the other 
hand, cases that raise little or no sputum may 
make poor progress, because of the unrelieved 
congestion of the affected portion of the lung. 

There are cases of tuberculosis in which an 
abundant sputum is practically the only symptom 
observable. Lindsay says : "Numerous cases have 
occurred in my practice in which tubercle bacilli 
were detected, although no definite signs could 
be made out, and the symptoms were merely 
suspicious." 

A man in this condition would naturally and 
wisely be anxious to have his sputum examined, 
but as I have already explained, examinations of 
sputum do not always demonstrate the bacilli. 

As I said before, the physician should always 
be willing to make examinations of sputum, and 
should always render an account of the result 
strictly in accordance with the facts. But it has 
happened, and it always will happen, that unless 



Relative Value of Temperature Changes 1 1 1 

a large number of such examinations of the same 
individual's sputum are made, all such examina- 
tions resulting in a definite negative, an unfortu- 
nate mistake can be made, unless the examination 
also demonstrates the presence of albumin. Under 
such circumstances it is best to take a short 
course of treatment. The sputum may not be 
tuberculous. Possibly a bronchial condition is 
indicated, or the after-effects of an attack of 
influenza are making themselves felt. Be that 
as it may, there is evidently something radically 
wrong with the air passages, or this unaccount- 
able and unusual amount of sputum would not 
be present. It is unnatural, it is suspicious, and 
should be relieved. 

While an increase in the expectoration is not 
necessarily a bad sign, a decrease may usually be 
looked upon as a favorable one. As the disease 
gradually comes under the control of the treat- 
ment the sputum becomes less disagreeable in 
odor, and of a paler color. Gradually it becomes 
whitish and glairy again, presenting about the 
same characteristics that it did when it first made 
its appearance. 



ii2 Tuberculosis 

There are similar paradoxes with regard to the 
temperature. Fever is a very important indica- 
tion of the presence of tuberculosis, but its severity 
or its mildness do not necessarily mean that the 
attack is correspondingly grave or otherwise. 
In some people the fever would be higher than in 
others, because of their difference in nervous or- 
ganization. In people of a lymphatic tempera- 
ment the fever may be very mild, or absent alto- 
gether, because they are so constituted as not to 
react strongly. The fever of tuberculosis is 
caused, not so much by the lung ulcer, but by the 
poisons of the bacilli circulating in the blood. 
Therefore, when we have much fever, we may con- 
clude that the bacilli in the lung, whether few 
or many, are causing active poisons, which are 
throwing the system, as a whole, into a febrile 
condition. 

Too much emphasis must not be placed on the 
presence or absence of fever, however. The dam- 
age to the lung may have become considerable 
before any temperature is observed. If we have 
a rise in the temperature of a patient, especially 
in the afternoon, in connection with other symp- 



Night Sweats 113 

toms of the ailment, it becomes easier to arrive 
at a decision in doubtful cases, but the absence of 
temperature does not discount these other symp- 
toms, if the latter are prominent enough to be 
worthy of note. "In a doubtful case," says 
Lindsay, "the presence of an afternoon tempera- 
ture is of great value, but its absence has little 
weight." 

Such an absence of temperature may indicate, 
not that tuberculosis is absent, but that the 
vitality of the patient is so great that his 
body force is successfully combating the debil- 
itating toxins in his blood. Such a patient, 
with a vigorous constitution on his side, stands 
every chance of recovery, if proper treatment 
is adopted without delay. 

The common but not invariable accompani- 
ment of fever are night sweats. These vary in 
severity, from a slight moisture or dampness 
about the neck and upper part of the chest and 
back, to a severe perspiration which may be 
profuse enough to wet the bedclothes through 
and through, not once, but several times in a 
single night. In cases where night sweats have 



ii4 Tuberculosis 

not yet put in an appearance, the increasing 
debility of the system is indicated by a clammy 
condition of the skin: the palms of the hands 
and the soles of the feet are especially likely 
to exhibit this symptom. Unless a number of 
other symptoms of tuberculosis are present, 
however, too much emphasis must not be placed 
upon sweating. Both day and night sweats are 
characteristic of some forms of debility, especially 
that due to long continued overwork, worry, etc. 

When sweating becomes pronounced, muscular 
weakness is usually correspondingly severe. Sleep 
does the patient little good. He arises in the 
morning, after a restless night, unrefreshed and 
very tired. 

Such a case will also show, in all probability, 
considerable emaciation or loss of flesh. This is 
one of the most constant symptoms of tuber- 
culosis, and one of the most reliable. "Wasting, 
attended by fever," writes Lindsay, "when not 
accounted for by some obvious condition . . . 
suggests the possibility of tuberculosis of the 
lungs. 

"If to these symptoms cough can be added, suspi- 



Fever and Loss of Flesh 1 1 5 

cion becomes strong, and if to wasting fever, 
cough, we can add hemoptysis (hemorrhage), 
the suspicion becomes a practical certainty." 
Loss of flesh is due to the fact that the waste 
of the tissues is greater than the digestive organs 
can repair. It is always a more serious symptom 
in cases where lung troubles are complicated by 
digestive disorders. These people either eat too 
little, or what they eat is not turned into nutri- 
tious body-building material. - Therefore, the vital 
strength of the system is being systematically 
reduced every day, and this in conjunction with 
the debilitating action of the disease itself makes 
the chances of the patient for recovery much less 
hopeful. The offset for emaciation, or loss of 
flesh, is liberal feeding, with wholesome and ac- 
ceptable foods. The digestive organs must be 
made strong enough to absorb every ounce of 
nutriment there is in generous and nourishing 
meals. If the effort to restore the digestive or- 
gans to health be successful, the patient begins to 
take on flesh, and may regain his lost weight 
quite rapidly. There is no one sign in the treat- 
ment of tuberculosis more favorable than this gain 



n6 Tuberculosis 

in weight, if what is gained be, not fat, but 
healthy flesh. 

Alcoholic beverages are sometimes recommended 
to consumptives as desirable, but it is my opinion 
that great moderation should be used in all such 
drinks. A little alcohol, in the form of good red 
wine, is sometimes advisedly prescribed, but those 
who use it to excess will injure themselves in more 
ways than one, and those who persuade a con- 
sumptive to drink liquor are giving bad advice. 

Excess in the use of alcoholic stimulants often 
has a tendency to develop a fat or bloated con- 
dition. It is not desirable to make a consump- 
tive person fat, unless at the same time healthy 
flesh is forming, and the constitutional condition 
is all that could be desired. Under any other 
circumstances, the increased fat would simply be 
another burden on the declining strength. 

Sometimes the loss of flesh, while continuous, 
is very gradual. It is possible under such cir- 
cumstances that a patient will neglect taking any 
form of treatment until after the loss of weight has 
become striking. The first sign of haggardness 
of feature, or protruding of bones, usually causes 



Skin and Bones 117 

alarm. The average patient will then discover 
several other, hitherto, unnoticed symptoms of 
lung trouble ; and there are some people who will 
invent a few. This symptom of loss of flesh 
is one of the most reliable of all signs of tuber- 
culosis, but it is surely foolish for a person to 
jump to the conclusion that he must have con- 
sumption because he is getting thin. 

Emaciation, a severe loss of flesh, means that 
the case is a severe one. To wait until one is 
approaching the skin and bone stage, therefore, 
is folly. This is addressed particularly to those 
who all their lives have been poor eaters and in- 
different weight gainers. Such patients add to 
the difficulties and anxieties of their physician, 
for it is absolutely essential that they shall over- 
come this lack of appetite and desire for food at 
once, and radically. To make his patient eat 
and also to digest and profit by what he eats, is 
in such cases the physician's paramount duty. 

If a treatment succeeds in changing one of 
these nibblers into a good, hearty eater, the 
chances of the patient for recovery are greatly 
increased, for the change itself is evidence that 



n8 Tuberculosis 

the vital strength and constitutional power of the 
patient increase correspondingly. There is even 
a likelihood that after the disease is overcome 
the patient will be, to all intents and purposes, 
stronger, healthier and heartier than he was be- 
fore he became infected. The result in such a 
case as this would mean that the tuberculosis was 
a blessing in disguise. 

It is very important that the patient should 
have his appetite increased whether he be losing 
flesh or not, for a good appetite makes it easier 
for him to keep dietary rules. It makes him like 
foods, possibly previously distasteful to him, 
which because of their powerful, strength-giving 
qualities should be, and must be, on every con- 
sumptive's bill of fare. 

Tuberculosis exercises a disturbing influence 
over the heart. This is an early symptom, and 
for that reason, particularly important. Some 
authorities contend that heart irregularity is one 
of the most significant of all the pre-tubercular 
signs. If it develop in a person who has hitherto 
had little or no heart trouble, it must be considered 
as suspicious. 



Heart Irregularities and Tuberculosis 119 

Just as an increase of weight is a good sign of a 
change for the better, so improvement in the 
heart action is an excellent indication of the 
effectiveness of the treatment used, and as a general 
thing, these two betterments will be noticed at 
about the same time. With the increase of 
weight, due to the action of the Tuberculozyne 
System of Treatment, there usually develops 
an improvement in his pulse rate, as the heart 
action resumes the normal. 

A person who has suffered more or less with 
heart irregularity, and who later finds himself 
afflicted with an obstinate respiratory disorder, 
should without delay consult a competent physi- 
cian, and submit himself, if so advised, to a thor- 
ough system of treatment, for statistics indicate 
that lung trouble generally, and tuberculosis 
in particular, run a stubborn course, when accom- 
panied by this complication. Among the inhab- 
itants of Leipsic, Messenberg tound that eight 
out of every ten cases of heart disease were also 
tuberculous. 

When the tubercularization is considerable the 
pulse rate, which in normally healthy individuals 



120 Tuberculosis 

is from 60 to 70 beats per minute, may increase 
to as many as 100, and in rare instances to as many 
as 120 or even 130. As a rule the more advanced 
the disease the higher the pulse rate, the usual 
range being between 70 to 100. 

Although there may be little danger of heart 
failure, any irregularity of the heart action is apt 
to alarm the patient, and, as I have elsewhere 
stated, success in the treatment of tuberculosis 
demands that the sufferer shall be calm and easy 
in mind and untouched by fear and worry. 

The patient should be made to understand that 
if he is subject to a disquieting palpitation of the 
heart on the slightest exertion, or after meals, 
this irregularity is a symptom which should give 
him no particular alarm. 

Minor effects of heart complication in tubercu- 
losis sometimes appear, such as watering of the 
eyes, a dropsical swelling usually seen under the 
eyes or about the ankles, and possibly a change 
in the color of the skin, which becomes of a waxy 
paleness or takes on a bluish, purplish appear- 
ance. 

Dyspnea, or breathlessness, is one of the most im- 




PLATE VII. 

Diffuse (Chronic) Pulmonary Tuberculosis. 

In the upper half of the lung there are scattered 
miliary tubercles and irregular areas of consolidation 
with a diffuse formation of fibrous tissue; the pleura 
is thickened. A large part of the lower lobe is firmly 
consolidated from tubercle tissue and exudate, and 
the result of breaking down of the lung. These 
regions are light in color, dense, hard and bloodless. 
Such conditions may last for some time before finally 
softening, breaking down and producing cavities. 




120 ilosis 

i s ; ate, may increase 

tances to as many 

• he more advanced 

rate, the usual 

of heart 
any irregul i *n is apt 

alarm the jflYcffrT^^ : '* e 

.gifioIuoidduT YTfinomli/l (^inoiHO) asufoiQ 

baislJBos stb sisik gnul st\i to tIbH laqqu aHj nl I easy 
noijfibilognoo 10 efisifi ifilusani bn£ gabiddui vrailim 
fiiualq adi ; auaaiJ zuoidE m noiJfionoi aauTiib b diiw , 
vJimR 8i ado! tsv/o! sHl 10 iiBq 9§ibI A .bsnajbim.ai 
bnB ,s}fibux9 bnB anssiJ abisdul moil baJfibiloznoo 
589rtT .gnul arfl lo nv/ob §ni>lB3id lo jlu89i aril 
.8 83 IbooId bns bisH ,98fi9b .toIod ni frfgil stb zrtoigai 
vjlanft 9-iobd 9miJ amoa to) tee I xsm anobibnoo HouS 
.eaiJivfio gnbuboiq bns nwob gnislfidid .gmirartoa 

Lies appei the 

eyes, a dropsical swelling usually seen under the 
eye it the an; ibly a change 

in i of the skin, w! >mes of a waxy 

palene- purplish appear- 

ance. 

Dyspnea, orbreathlessness.isoneof themostim- 



Noisy Breathing 121 

portant symptoms of tuberculosis. Strictly speak- 
ing, dyspnea is more than breathlessness ; although 
shortness of breath is the most common and dis- 
tressing variety of dyspnea. Dyspnea, also, compre- 
hends changes in the manner of breathing, changes 
in the depth of inspiration, and changes in the 
sound made by both the drawing in and forcing 
out of the breath. 

In the absence of other distinctive symptoms 
of tuberculosis, dyspnea would be misleading, 
for it is seen also in heart disease, intercostal 
rheumatism, chlorosis, cancer, obesity, dyspepsia 
and brain trouble. A patient and his friends 
begin to realize that the former's breathing is be- 
coming noisy, whereas breathing should be an 
absolutely noiseless function. One man, for in- 
stance, will snuffle when he draws in a breath; 
another will make a singing, sighing or whistling 
sound ; a third appears to be obliged to exert some 
little effort to fill his lungs. This is the asthmat- 
ic?! form of dyspnea. 

These difficulties are never present in a per- 
fectly healthy individual, and point unequivocally 
to some unnatural condition of the air passages. 



122 Tuberculosis 

When present they should be given attention with 
the idea of determining their exact cause. 

Dyspnea is a more or less pronounced symptom 
of all forms of lung trouble, and is as frequent in 
bronchitis as in consumption. There is neither 
sense nor safety in neglecting lung trouble, even 
if it is not tuberculous. If that fact can not be 
definitely determined, dyspnea, from whatever 
cause arising, should, nevertheless, be given due 
consideration. If the dyspnea be growing worse 
from day to day, if the patient find himself 
growing progressively less able to indulge 
in even the mildest sort of exertion, there is reason 
enough for seeking medical advice. We all 
know that middle-aged people of a sedentary 
mode of life, and fat people also, are apt to have 
difficulty with their breathing, not because they 
are tuberculous or have heart disease, but simply 
because they have allowed the passages to close 
up more or less through disuse. Such a condi- 
tion is harmless and common enough. It must 
not be confounded with the dyspnea, of true 
lung disease. It takes only the most limited 
powers of observation, however, to distinguish 



Examine the Other Side 123 

the difference between the labored breathing of a 
healthy fat man, and the corresponding distress of 
a tuberculous, or bronchitic patient. 

One of the oddest symptoms of disease in the 
lung is an expansion of the nostril with each in- 
spiration made by the afflicted person. This sign 
should be sought in connection with a waxy nose, 
pallor and purple finger-tips. Add to these symp- 
toms of lung trouble other signs, such as deform- 
ities of the chest, cough, wasting, expectoration, 
fever, etc., and a fairly complete and reliable pic- 
ture of tuberculosis will have been drawn. If 
the patient breathes with evident difficulty, and 
the complexion is unnatural, and the nostrils work 
in and out with every breath taken, says Lindsay, 
the combination should suggest tuberculosis, even 
in the absence of emaciation. 

One peculiar effect of lung obstruction is that it 
causes the patient, w T hen resting, to he on the side 
of the unobstructed lung. When he does so the 
secretion in the air passages is drawn off by 
gravitation, and this eases the breathing. In 
many cases it would be safe to decide if a person 
lies on one side or the other, because it enables 



I24 Tuberculosis 

him to breathe more easily, that the lung on the 
other side is obstructed. The mean preference of 
lying on right and left side when accompanied by 
no distress, if position is reversed, is of course 
natural and common and of no diagnostic value. 
Only when natural relief is experienced when 
resting on one side and distress occurs when lying 
on the opposite, is this symptom of importance. 

When respiration is notably altered, much 
quickened and quite shallow; when the movement 
of the chest is altered from normal, and the 
up and down motion of the diaphragm is notice- 
ably changed, the case is one of considerable 
severity. If possible, these conditions must be 
improved without needless delay, for the blood 
is not being properly aerated. It is of little avail 
to bring the digestive organs to a state of efficiency, 
and then permit dyspnea to nullify their work 
by preventing the aeration and purification of the 

blood. 

The foregoing illustrates the fact which I think 
has gradually become apparent, and which I wish 
to emphasize now particularly: the treatment of 
tuberculosis is no simple matter. Not one pre- 



Disease Must Yield 125 

caution, but every precaution must be taken be- 
fore such treatment is worthy of the titles, modern 
and scientific. The treatment should be able to 
arouse, marshal and direct the forces of nature 
so that an overwhelming vital resistance to the 
further progress of the disease is organized. 

Such a comprehensive gathering together of 
the forces which assist nature has been aimed at in 
the development of the Tuberculozyne System of 
Treatment, during the several years devoted to 
its perfection, realizing the great truth that, if the 
full powers of the human body are organized and 
inspired to act, disease must yield if too great 
destruction has not already taken place in the 
vital organs. 

Nine times out of ten hemorrhage is a faithful 
sign of tuberculosis. Dr. Minor attributes the 
majority of hemorrhages to tuberculosis. Strick- 
ler, in examining many cases among German 
soldiers, found eighty-six out of every hundred 
were infected with tuberculosis, although none of 
these men suspected it previous to the advent of 
the hemorrhage. Another investigation showed 
two hundred and eighty-two out of three hundred 



126 Tuberculosis 

and seventy-nine cases of hemorrhage were tuber- 
cular. This would indicate that in eight hemor- 
rhages out of every ten, diagnosis of consumption 
would be correct : yet hemorrhage may be and in 
rare instances is, induced by other causes than 
tuberculosis, such as severe internal injury. 

A very large number of tuberculous patients are 
first made aware of their condition by a more or 
less copious hemorrhage. Previous to its appear- 
ance, such persons are usually, for a longer or 
shorter period, in a run-down condition. They 
lack energy and snap, tire easily, are nervous, 
and not refreshed by sleep. In most cases a 
little cough and some expectoration precedes the 
hemorrhage. Ofttimes these two symptoms are 
so trifling and commonplace that they are over- 
looked. Many such cases, also, have a history of 
recurrent or continuous colds for months, or even 
years previous to the day of the hemorrhage. A 
little sweating and some fever may antedate the 
hemorrhage by a few weeks, but they are seldom 
given any particular attention, being confounded 
with the general feeling of ill health of which the 
sufferer is complaining. 



Hope Soon Returns 127 

Then, on a day, or in the night, there comes a 
warm, sweet, sick feeling in the chest, and up 
comes a mouthful of bright blood. Careful in- 
quiry will usually discover an immediate cause for 
the hemorrhage, such as a blow, excitement, ex- 
ercise, a severe fit of coughing, damp weather, 
a hot spell, a hearty laugh, a sudden movement, 
and, in women, the pre-menstrual period. 

The immediate effect of the first hemorrhage 
on the mind of the patient is apt to cause a 
feeling of despondency. He has a feeling in his 
heart that all is over, hope is dead, effort is a 
mockery. Strange to say, however, after this 
despondency has passed away, which it soon does, 
the patient is never affected with it again, no 
matter how many hemorrhages he may have. He 
soon learns that they are not dangerous, that the 
amount of blood lost is insignificant, and the 
symptom itself has little bearing on the severity, 
or otherwise, of the disease. There may be quite 
copious hemorrhage with only very slight tubercu- 
lari zation of the lungs ; and, vice versa, a trifling loss 
of blood, or even no hemorrhage at all, notwith- 
standing large areas of the lung may be destroyed. 



128 Tuberculosis 

Loss of blood seldom exceeds two ounces. 
It usually appears more, owing to the exaggerat- 
ing effect of fear, or because it is expectorated 
into a vessel containing water. There are cases on 
record of immense losses of blood. The raising 
of ninety -four ounces in twenty-four hours is the 
record. Smernow reports a loss of ninety-seven 
ounces in three days — with recovery! These in- 
stances are abnormal, but the common severe 
hemorrhage, though frightful in appearance, 
seldom seriously affects the general condition of 
the patient. In fact, and I take great pleasure 
in making it known, many patients date the be- 
ginning of their recovery from the day of the 
first hemorrhage, which often relieves the con- 
gested condition of the affected portion of the 
lung. 

Strange to relate, it is not, as might be supposed, 
the thin, weak, and debilitated patient who is 
most liable to hemorrhage, but the ruddy, weil- 
nouiished individual, who delights in outdoor 
exercises. This seems like a mystery, but is 
simply due to the fact that the vigorous individual 
puts a greater strain on his veins and arteries by 



Tracing the Blood 129 

his exertions. Spring is the favorite season for, 
and twenty to thirty the most likely age at which, 
this symptom will put in an appearance. These 
two circumstances are explained, as was the 
hemorrhage of the vigorous patient, in a very 
simple way: spring is a period of activity, and 
between twenty and thirty are embraced the most 
active years of life. 

As a sign of disease in the lungs, hemorrhage 
is so important that it is very desirable to deter- 
mine positively that the blood comes from those 
organs, and not from some other part of the body. 
Occasionally there is a blood vomit from the stom- 
ach of a person suffering with lung trouble. 
There are striking differences between hemor- 
rhages and a blood vomit. In the latter the 
amount of blood will be considerable, dark, even 
almost black, accompanied by stomach pains, 
and probably preceded by the vomiting of particles 
of food. A blood vomit ends almost as abruptly 
as it begins. 

In lung hemorrhage, the blood is not vomited, 
but coughed up. It is not black, but froth}?-, 
mixed with air, so that it has a bubbly appear- 



130 Tuberculosis 

ance, and bright red. The discharge of blood 
does not end suddenly, but is usually followed by 
more or less spitting of blood for several hours or 
days afterwards. 

Nature has its own effective ways of stopping 
the flow of blood, and will not fail to put them into 
immediate effect when the hemorrhage is of a 
minor character, if the patient He down and 
rest and abstain from food for a few hours. 

Different modes of onset are observed in 
tuberculosis. We have already described the 
insidious and catarrhal types. These with the 
hemorrhagic cases are the three types most con- 
stantly observed. It is a little difficult to believe, 
because of its spectacular character, that of the 
three types, the hemorrhagic is the more favor- 
able as regards recovery. If, in a case of this 
kind, the appetite can be increased, the nerves 
quieted, and the body kept in a vigorous state of 
preservation, the prognosis is good, provided the 
patient through his entire treatment will faith- 
fully follow instructions, and has will power not 
to become careless or negligent, because he is 
making rapid and decided progress toward re- 



Reasons for Immediate Treatment 131 

co very. Improvement from almost the very 
beginning of treatment may cause the patient 
to become too sanguine, and result in his failure 
to continue a sufficient length of time to ensure 
entire and complete eradication of the disease. 

Time and patient observance of instruction 
given by the physician is necessary in all cases for 
complete recovery. 

Owing to the fact that the patient can infect 
himself in other parts of his body with bacilli from 
the lungs, it sometimes happens that the lung 
trouble is complicated with outbreaks of the dis- 
ease elsewhere in the body. The case then be- 
comes a much more serious one. This extension 
of bacilli is an accident liable to happen to any 
consumptive, however mild the case may be. 

While there is a colony of bacilli in the body, 
there is no guaranty that general tuberculosis 
will not develop at any time. They may enter 
the circulation through swallowing of sputum, 
by penetrating a blood vessel, or by being taken 
into the lymphatic glands through the action of 
the lymph. As soon as they enter the circulation, 
they are attacked by the white blood corpuscles, 



132 Tuberculosis 

and carried by these vigilant little soldiers of the 
system into the remotest branches of the arteries 
and the blunt ends of the veins. Here, with sur- 
roundings just to their liking, they will proceed 
to increase in number, unless the leucocytes 
succeed in destroying them. 

A favorite lodging-place of such escaped bacilli 
are the joints. Tuberculosis of the joints, first 
observed as a very slow, deliberate, almost pain- 
less, impairment of motion, results. The joints 
swell, gradually increase in size, and may become 
useless in time. 

As a rule, an abscess caused by the germs breaks 
down sooner or later, and the released pus burrows 
its way to the surface, causing a very ugly and 
stubborn ulcer. The bones of the hip joint and 
knees are the favorite locations for this mani- 
festation of the disease, the former causing, when it 
begins in childhood, the familiar deformity known 
as hip-joint disease. 

As the tubercle bacillus, once it escapes into the 
circulation, may infect almost any organ of the 
body, such as the liver, kidney, special organs, 
intestines or brain, such an accident should be 



Blood Purification 133 

prevented if possible, for every new focus of the 
disease largely increases its severity. Once the 
bacilli reach tissue outside the lung, the body 
can no longer bring into play that splendid device 
of nature for getting rid of the germs, viz., the 
cough. 

The system has no means of mechanically rid- 
ding itself of the bacilli, when they are located 
in the liver, the kidneys, or the glands. There- 
fore, the treatment adopted must be powerfully 
searching and anti-tuberculous, if any progress is 
to be made toward recovery. A general syste- 
matic course of treatment, preferably one that has 
the power to make the blood more antagonistic to 
the vitality and further increase of the germs, is, 
therefore, of supreme importance. 

That the Tuberculozyne System of Treatment 
has far-reaching and subtle effect is indicated 
by the results obtained in cases of generalized 
tuberculous disease. A marked improvement 
in diseased joints and tubercular glands has been 
noted after the treatment had been taken but a 
few weeks. 

When it is remembered that tubercular affected 



!34 Tuberculosis 

joints have generally been considered hopeless by 
even the most enthusiastic believers in the cura- 
bility of lung tuberculosis, we think this must be 
considered a truly remarkable achievement for 
the Tuberculozyne System of Treatment. 

Reference may be had to the appendix accom- 
panying this book for records of cases of the 
various forms of tuberculosis treated success- 
fully by the Tuberculozyne System of Treatment. 
Consumption has a larger number of women 
victims than men, probably owing to the greater 
instability of their nervous systems and the un- 
hygienic mode of living, confined in close houses, 
as followed by the majority of the sex. Women 
also take less open air exercise than men. Women, 
furthermore, are exposed to drains upon their 
vitality such as that caused by excessive child- 
bearing and long-continued nursing, that the 
other sex escape. These two latter are prolific, 
predisposing causes of tuberculosis, for they 
drain the system of its resistive power. As a 
compensation for their greater liability to the 
disease, tuberculosis usually runs a milder course 
in women than in men, and it is probably due to 



Nature Knows Best 135 

this fact that the mortality of the sexes is about 
equal. 

The most striking effect of tuberculosis in 
women is its interference with the menses. It 
may cause a missing of the period for months be- 
fore specific signs of the disease develop. Delayed 
menses, therefore, in a female whose health 
seems to be on the decline, is a diagnostic sign of 
the utmost importance, for if correctly interpreted 
it may lead to the adoption of anti-tuberculous 
treatment at just that early stage of the disease 
when it is most rapidly and easily cured. 

In many cases, after the tuberculosis has gained 
a good foothold, the menses stop entirely, and no 
efforts, which, by the way, are uncalled for, will 
bring them back until the disease is arrested. 
Return of the menses naturally, while treatment 
for tuberculosis is being taken, is a splendid sign, 
for it means that the strength of the system has 
been sufficiently restored to enable it to support 
this additional drain upon its resources. 

There is a popular belief that the stoppage of 
the menses is a very bad sign, and that the sub- 
sequent decline of the (usually young) woman is 



136 Tuberculosis 

due to this stoppage, while the fact of the matter 
is, the exact opposite of this is true. Nature, 
recognizing it has a stubborn enemy to com- 
bat, automatically stops the menstrual flow in 
order to economize the vitality of the system. 
In other words, it stops this periodical drain upon 
the organism because the strictest economy of 
the strength is now in order, if the individual is to 
be preserved. 

This fact needs to be kept in mind by all women : 
this function will only be restored when the 
strength of the blood has been so far regained that 
the flow can be safely resumed. 

Hemorrhage is more likely to occur in women 
during this period than at any other, and the 
menstrual flow has the effect also of increasing 
fever. Tuberculous fever often appears a day 
or two previous to the menses, and continues two 
or three days after it has begun. Small wonder, 
therefore, that nature quickly decides to relieve 
herself, for the time being, of this unessential and 
burdensome drain. 

Although so important a leading symptom of 
tuberculosis in women, stoppage of the menses 




•LATE VIII. 



Pulmonary Tuberculosis (Chronic) with Large 
Cavities. The ragged communicating cavities in- 
volve a large part of the lung, and originated in the 
bronchial tubes. The bronchial lymph-nodes are 
enlarged, and the pleura is thickened by the forma- 
tion of dense fibrous tissue. 




J 3 6 Tuberculosis 

due to this stoppage, while the fact of the matter 

is, the exact opposite of this is true. Nature, 

rec ' stubborn enemy to com- 

the menstrual flow in 

the vitality of the system. 

1 stops this periodical drain upon 

organism because the strictest economy of 

the strength is now in on , j is to 

.111 V J1AJH 

agisJ djiw (oinoiiO) eiaoIuoi^duT yiBnomlu* 1 ! 
-ni B^iiiVBO gnilBoinummoo baggei aHT .aailiveD 
sHj ni batenigna bns ,gnul aHl }o lisq agifil b avlov 
9iB zabon-Hqmx! IfiinDfioid sHT .zadirt ifiirbfioid 
-Bono} gHj yd bansjbiffo si Btuslq aril bnB .bagifilna 
.9U88JJ auoidn" aansb lo noil 
during this period than at any other, and the 
menstrual flow has the effect also of increasing 
fever. Tuberculous fever often appears a day 
or two previous to the menses, and continues two 
or three days after it has begun. Small wonder, 
therefore, that nature quickly ev g 

herself, for the time being, of thi ttial and 

burdensome -drain. 

Although so important a leading symptom of 
tuberculosis in women, stoppage of the menses 



Study this Point Carefully 137 

is not a positive sign of the presence of the disease, 
and in the absence of other suspicious symptoms 
cannot be considered as having much diagnostic 
importance. Girls fall into decline from other 
causes besides tuberculosis, as, for instance, 
chlorosis and anemia. It is a mooted point, 
however, just what relationship these two dis^ 
eases have to tuberculosis. We should, therefore, 
consider this symptom carefully in relation to 
accompanying symptoms that are common in, 
and characteristic of tuberculosis, realizing that 
it increases in importance as a diagnostic sign in 
exactly the same ratio as other symptoms of 
the disease present gain in plausibility. 

The progress of a case of pulmonary tubercu- 
losis toward recovery may be quite steady and 
deliberate, if the case is placed in proper hands 
early enough. It is a very deceptive ailment, 
however. Bad cases often do well, while appar- 
ently hopeful cases make slow progress. 

There is no doubt in my mind that this apparent 
variability in the character of the disease is some- 
times the result of the degree of fidelity with which 
patients live up to their instructions. There are 



138 Tuberculosis 

individuals who, no matter what the cost, will 
please themselves, and if the commands of their 
doctor interfere with their desires, so much the 
worse for the commands. 

Many a hopeful case has been set back weeks, 
or even months, by one evening's self-indulgence. 
The inclination of such a patient may be aided 
and abetted by the very progress made up to that 
time toward recovery. He feels so strong and 
well that he considers he can safely allow himself 
a little latitude. Therefore, a treatment that 
can act quickly is doubly to be desired, for it 
shortens the period of self-denial and thereby in- 
creases the chances for recovery of those adven- 
turous individuals who love to speculate, even 
though the stake is life itself. 

People of sanguine, enthusiastic temperament, 
people with reddish or blond hair and delicately 
organized constitutions, with high-strung nerves, 
unduly sensitive, and often intellectually brilliant, 
are not only the most frequent victims of tuber- 
culosis, but also make the poorest patients. 
This is because they are difficult to control, having 
strong impulses of their own. They are free souls, 



Splendid, Solid Benefits 139 

chafing at all kinds of restraint even though, 
paradoxical as it may sound, restraint is the price 
of freedom. With such people it is no use to 
argue. Simply say to them that there is only 
one alternative: either submit to a little dis- 
cipline for a while, perhaps not as long as you 
think, or else venture the consequences. 

The rewards promised this nervous, irritable 
type of patient are the joys of a glorious appetite, 
sound and refreshing slumber coming unbidden 
at the hour desired, a greater capacity for exer- 
tion, and a better presence, due to an increase 
in the potential energy of .the organism. These 
are very solid blessings, indeed, and if regained 
and maintained, are ample compensation for any 
minor restrictions of treatment, which, because 
they break in on the ordinary routine of life, may 
be found irritating. A speedily acting treatment 
also makes it possible for even severe cases to 
quickly rehabilitate themselves to such an extent 
that practically a normal mode of life can be re- 
sumed without prejudice to the further successful 
prosecution of the treatment. 

The most favorable results are obtained in the 



140 Tuberculosis 

wiry, sometimes thin, but always energetic type 
of patient. These people seldom find their 
energy much impaired by the disease, and it is 
usually a very easy matter to bring their appetites 
and their digestive powers to a high state of 
efficiency. Their hearts seldom give any trouble, 
— a splendid sign, — there is little or no fever, and 
their lungs show early a strong tendency toward 
fibrosis, or the imprisonment of the germs in a 
tough, fibroid sac. 

In tuberculosis mental strain, worry, anxiety 
and despondency act to retard the progress of the 
case toward recovery. At the International 
Tuberculosis Congress held in Washington re- 
cently, (which Congress was attended by the 
author), Professors Charrin and Roger gave the 
results of their investigations on this point. 
They declared that long-continued physical or 
mental strain, with anxiety due to responsibility, 
overwork, and useless worry, were most potent 
predisposing causes of tuberculosis. They proved 
that excessive exertion, especially that of an unpro- 
ductive and monotonous character, had a power- 
fully predisposing influence toward tuberculosis. 



Loss of Ambition 141 

No system of treatment in tuberculosis can 
exercise its greatest power for good unless the 
mental attitude of the patient is also favorable 
to a steady progress toward recovery. If the 
patient indulge in needless worry, gives himself 
up to seasons of despair, if he show a tendency 
to the "what's the use" attitude of mind, he is 
not only discounting the treatment, but also 
aggravating his disease. 

The peculiar mental attitude of the pre-tuber- 
culous and the tuberculous patient has been sub- 
jected to careful scrutiny. It has been found 
that in its earlier stages the disease may affect 
the mental and spiritual man. The good-natured 
individual becomes captious, peevish, finicky. 
His temper suffers, and though he may not wish 
to hurt the feelings of his loved ones, he never- 
theless does not spare them the sting of his 
pessimistic humor. 

We may also observe, in some instances, a sort 
of weakening of the character. The formerly 
ambitious and persevering man, the man who 
loved order and system, becomes slovenly and 
slipshod. There are instances where a man 



142 Tuberculosis 

previously scrupulously exact and just in his 
financial, business and social relations with other 
people, becomes lax, indifferent, and even blame- 
worthy; not because he has any real desire to 
shirk his obligations, but because his physical 
condition seems to have destroyed and nearly 
shattered his former faithful and generous mental 
character. 

The effect of wholesome treatment in such 
cases is very striking: often hope is renewed, 
the fear of immediate death is removed, and 
life again seems desirable. From that time on- 
ward the patient develops a faith in his ultimate 
recovery. Under such conditions the result is 
almost sure to be a favorable termination of the 
case. 

Some scientists hold that tuberculosis strikes 
down only the unfit and degenerate. Human 
experience refutes this view. Does it not seem 
that the disease prefers as a victim the talented, 
the fine and the lovable ? There is an old heathen 
proverb: "Whom the gods love die young," and 
observation would seem to indicate that these, 
not only the loved of gods, but also of men, are as 



From the Shadow of the Valley 143 

frequently, if not more frequently, stricken down 
by this almost universal plague, than are those 
who can be more easily spared. 

Personality is of much importance. It may 
determine the future prospects of the patient. 
If he have courage and a light heart, if he can 
snap his fingers in his enemy's face, there is more 
than one good reason why he should recover. 
A strong will to live, not merely a weak wishing, 
but a firm, calm determination to live, will carry 
a man past almost any pathological disaster. 
Every physician knows this is true, and having 
the welfare of his patient at heart, always tries 
to arouse this Spartan spirit. 

Practically every reader of this book knows 
that mind has a wonderful mastery over matter, 
especially when that matter is body tissue. We 
all know of cases where only the indomitable 
courage of the sick person kept the spark of 
life burning in his body, until the crisis was past 
and he came triumphantly back from the very 
shadow of the cypress. 

Any and all forms of lung disturbance, whether 
known to be tuberculous or not, should be rec- 



144 Tuberculosis 

tified at once, for the most fortunate thing that 
can happen to the consumptive is that his disease 
shall be recognized and properly treated in its 
earliest manifestations. 

Authority for the foregoing statement appears 
in every work on tuberculosis issued in the last 
ten years. It is also the theme of the professors 
in all the colleges. It is insisted upon in the 
daily bulletins of municipal health departments. 
One of the latter recently issued a bulletin ad- 
dressed to the physicians in New York City. 
Among other things this circular contained the 
following statement: 

"Incipient (early) tuberculosis tends toward 
recovery." In all coughs which last more than a 
few weeks (unless otherwise explainable), tuber- 
culosis is to be suspected. Successful treat- 
ment DEMANDS EARLIEST POSSIBLE DIAGNOSIS. 

It was with this latter thought in mind and 
also that all might be said possible to emphasize 
the necessity for early treatment in lung ailments, 
that I went into such minute detail as to symptoms 
in the foregoing pages. 

Assuming that this has served its purpose and 



From the Shadow of the Valley 145 

that the person who has reason to be concerned 
regarding the conditions of his lungs is properly- 
aroused, the next following and important ques- 
tion is that of treatment. 

NOTE 
The appendix mentioned in this book is printed 
in separate form, and should be preserved for 
purposes of reference. 

If lost or mislaid, write for another copy, which 
will be mailed free of charge. 

The Yonkerman Company, 
Kalamazoo, Michigan, U. S. A. 



PART III 



METHOD OF TREATMENT 

SANATORIUM TREATMENT 

SANATORIUM AND HOME TREATMENT COMPARED 

DETAILED DESCRIPTION OF MODERN HYGIENIC 

TREATMENT 



Method of Treating Tuberculosis 149 

Those who adopt the Tuberculozyne System 
of Home Treatment are thoroughly advised as to 
mode of life, diet, bathing, rest, management of 
symptoms and general measures of that character. 
They are shown how to secure the benefits of life 
in the open air, given instructions how to adapt 
the home surroundings in accordance with the 
best modern ideas of sanitation. In addition, 
they are provided, without extra charge, with all 
such medicines as may, in the judgment of the 
physician in charge of the case, be necessary to 
counteract unfavorable developments, and also 
given a thorough course of medical treatment. 

Combined with Tuberculozyne medical treat- 
ment, the hygienic measures included in the 
Tuberculozyne System of Treatment gain, I be- 
lieve, immensely in effectiveness. 

That these hygienic measures are very compre- 
hensive, modern and up to date can be gathered 
from the following: The patient is given the 
benefit of every hygienic method for aerating 
the blood, and keeping the lungs flooded with 
pure air. He is instructed how, when, and of 
what his meals should be composed. It fully 



150 Tuberculosis 

covers the questions of exercise, rest and sanita- 
tion. It takes care of the digestion, the proper 
regulation of the bowels, bathing, mental thera- 
peutics, and the correct care of the body. Regular 
detailed reports from each patient are required, 
and all reasonable discipline is insisted upon, 
yet the directions, because they are carried out in 
the patient's own home, are not irksome. 

As the Tuberculozyne System of Treatment is 
purely a home treatment, the evidence of its 
efficacy found in the accompanying appendix 
gains peculiar significance and value to every 
tuberculous or even pretuberculous person. Of 
late years, owing to the wide advertising of 
Arizona, Colorado, Egypt, mountains and sea 
voyages, as essential adjuncts in the treatment of 
the disease, the public has come to think that the 
moment it is ascertained a person has contracted 
consumption, he must necessarily pack off to 
some sanatorium. There is a sort of general 
impression, also, that the farther away, and the 
more inaccessible this sanatorium is, the more 
powerfully curative a residence there would prove 
to be. 



Off to a Sanatorium! 151 

That the sanatorium method of treatment has 
its merits is not to be denied, but an examination 
of what sanatorium treatment consists of dis- 
covers that its chief elements are hygienic dis- 
cipline, an abundance of fresh air, proper diet, and 
rest. In other words, if the patient is benefited 
at all by his residence at a sanatorium it is because 
he is there compelled to adopt a hygienic mode of 
life, and made to live largely in the open air. 

During a four to six months' stay at a sana- 
torium, a patient will usually make decided prog- 
ress, and also gain sound views as to hygiene 
and sanitation. But that this is not all that is 
necessary is proved by the fact that only too 
often the gain made is soon lost. 

According to the statistics of the German 
Imperial Health Office only 21 per cent, of those 
reported cured by sanatorium methods were able 
to work four years later, although the original 
proportion of those discharged as cured was 
eighty-seven in one hundred. This shows that 
fresh air and hygienic methods are powerful 
factors in treatment, but apparently something 
else is necessary to assure permanency of results. 



152 Tuberculosis 

Dr. West, one of England's greatest authorities, 
says: "Sanatorium treatment cannot change the 
natural course of the disease. It will not cure 
the disease, but assists the patient to resist." 
Lindsay, in the same connection, declares that 
climate "is a means to an end; not a complete 
therapeusis" (system of cure). 

All that climate — sanatorium treatment — is 
good for, in his opinion, is to improve appetite, 
nutrition, and promote happiness. If we can do 
this in any place, then that place is as suitable as 
another for the successful management of the 
disease. We know there are some who think 
climate is a specific in tuberculosis, but this view 
is no longer maintained by the authorities, except 
in very unusual and comparatively rare cases. 

The reports of the effects of the Tuberculozyne 
System of Home Treatment would indicate that 
these results would be obtained without going to 
a sanatorium. Consequently, such objections as 
are made to the latter form of treatment gain in 
authority. 

One of the chief drawbacks of sanatorium 
treatment is that it is too expensive for the average 



An Expensive Method 153 

person. Association with so many other tuber- 
cular people has a bad effect upon many patients. 
The chief subject of conversation in these fresh 
air hospitals is symptoms, symptoms, symptoms; 
and the majority are continually expressing the 
wish, after the first two or three weeks, that they 
could leave the place and go back home. Con- 
stant talking about and dwelling upon their 
various symptoms and ill feelings has an extremely 
depressing effect on any patient. Many an- 
ticipate their departure months ahead of its ar- 
rival, and keep themselves and every one around 
them in a ferment of homesickness. 

As a usual thing, because of the desire of the 
average patient to get back home, and the finan- 
cial limitations of many, the course of treatment 
taken may be much too short, and the instant 
there is noticed any decided gain in their condi- 
tion, away they go, back home. 

Entertaining the idea that they are recovered, 
they fall back quickly into their former mode of 
life, with the result, as statistics indicate, that 
quite a number relapse sooner or later. 

At home, conditions for the successful carrying 



1 54 Tuberculosis 

on of treatment can be made almost ideal. The 
patient is relieved of the worry consequent 
on an outlay which, in many cases, he can ill 
afford. With a little effort almost any home 
can be turned into an open air sanatorium, and 
there is no reason why the average patient 
should not be able to follow hygienic methods as 
successfully in his own home as in a sanatorium. 

Given these requirements, the patient enjoys 
advantages only a home can supply. He has the 
companionship of his friends and loved ones. He 
is surrounded by solicitous care, which is unmarred 
by even the suspicion of mercenarism. He 
escapes the sense of loneliness that preys on al- 
most every sanatorium patient. 

At home the patient's mind may be made placid 
and contented; his courage sustained by the for- 
titude of those whose heartfelt desire is that he 
shall recover. With these conditions established, 
home may be the one place most conducive to 
the patient's recovery. 

Those in moderate circumstances, by staying 
at home, and thus relieving themselves of the 
expense inseparable from residence in a sana- 



Serious Worry Prevented 155 

torium, are made financially better able to com- 
mand appropriate clothing and those luxuries 
of the table so necessary, because of their 
variety and nutritiousness, to keep them 
in a contented frame of mind as well as fortify 
their strength. When at home, the business 
man also finds less occasion to worry regarding his 
business or other occupation. When he is sep- 
arated from his means of livelihood, not only by 
distance, but by the express commands of his sana- 
torium physician that he shall forget it entirely, — 
abandon it; in fact, he is very apt to worry. 
When the patient, instead of going away, stays 
at home, however, this source of worry is avoided. 

The object of sanatorium treatment is to 
flood, as it were, the tubercular area with healthy 
blood by pure air, restore the digestive organs, 
rebuild the nerves, and produce flesh and strength 
by proper food and rest; and since all these re- 
sults have been and are every day accomplished 
in patients' homes, there is no imperative neces- 
sity for the patient going away. 

I believe that many will be very glad, indeed, 
to know that the necessity for going away applies 



156 Tuberculosis 

only in a comparatively few cases. There are 
few consumptives to whom leaving their homes 
and families is a pleasant prospect. They will be 
glad to learn, therefore, that a long journey from 
home and a residence of months in some distant 
sanatorium, with its attendant expense, is not an 
essential of success. 

It is the duty of the physician to inspire, if 
possible, enthusiasm and hope in the patient, 
and the physician is in a position to do this with 
greater success than any one else, for he can 
often see by the reports of his patient that an 
improvement has actually taken place, whereas 
to the patient no improvement is noticeable. 
At such times, when despondency asserts itself, 
the patient needs an educated, sympathetic 
friend, such as his physician should be, to point 
out to him just why and when his condition is 
improved. A convincing heart to heart talk or 
letter at such a time will often do more to inspire 
his courage than a week of routine treatment. 

The patient's mental activity should be given 
direction and impulse, if necessary. The body 
is simply the servant of the mind, and is under the 



Fortifying the Courage 157 

influence of the mind at all times. If the mind 
be depressed, the tissues lose tone, and it is known 
that, under the influence of melancholy, anger, 
and other emotions, some of the secretions of 
the body become violently poisonous. This 
proves mind has a wonderful control over the 
physical body, and so, both patient and physician 
must work together, to ensure healthy and 
cheerful thoughts at all times. It is a splendid 
thing to give the patient an object in life, for 
this inspires the will to be and to do, which has 
tremendous sustaining power. It is quite proper, 
I think, under the circumstances, for the patient, 
if he sees fit to discuss his business or social 
affairs with his physician, but, of course, under the 
seal of secrecy, so that the latter may, in his wisdom, 
direct the former, if possible, toward a greater ma- 
terial success. To prosper in one's undertaking 
and to be successful in life, gives wonderful energy 
and impetus to the human system. 

The regulation of the digestion and its de- 
velopment into a strong, powerful and depend- 
able function of the body, is one of the immediate 
and most important duties of the physician. 



158 Tuberculosis 

It is really remarkable how stubborn dyspepsia 
can be when improperly treated, and how quickly 
a competent medical man can, with the proper 
remedies and diet, cause it to disappear. It 
seems magical, but like all wonderful happenings, 
when understood, it has nothing of the uncanny 
or occult about it, but simply illustrates the 
certain effectiveness of real scientific knowledge. 

Food science has been developed in the last 
few years into a wonderful strength -building 
system, and by its means the physician in charge 
of a case of tuberculosis can usually banish the 
signs of dyspepsia, and rapidly inspire the nutrition 
of the entire system. 

The bill of fare of the tuberculosis expert looks 
very familiar to the average person, and at first 
glance does not appear different in any way from 
the meals served in the ordinary home; but a 
chemist acquainted with the constituents of 
foods would see at a glance that the meals of the 
expert were so balanced as to furnish not only 
the maximum amount of pleasure, but also the 
maximum of heat, strength and fat -forming 
elements. 



Food Values 159 

The physician, when he makes out his bill of 
fare, knows just what he wants that meal to do. 
He wants to provide his patient a certain amount 
of energy, with a certain amount of excess fat, 
with a certain amount of new tissue. He orders 
foods, therefore, which will be turned into just 
these organic qualities. 

To the healthy man to know the proportion of 
protein, hydrocarbon, etc., in the articles he eats, 
is of little interest, but to the tuberculous man or 
woman who is fighting a sleepless and relentless 
foe, seeking hourly and momentarily to under- 
mine the fotmdations of his or her constitution, 
this intimate knowledge of food values is very 
important, and if he does not possess it himself, 
he should be under the direction of the physician 
who does. 

A competent physician can do much for his 
patient to make life easier and happier. If there 
are certain distressing symptoms of a trifling 
character, such as heartburn, headache, etc., he 
can easily instruct his patient how to overcome 
them by simple household means. He can also 
suggest delightful dishes, such as the recipe for 



160 Tuberculosis 

egg albumen, which makes a most delicious morsel. 
It is his business to know when to advise raw or 
partially raw meat instead of that which has 
been cooked; or dessicated meat, when the latter 
would be more sustaining than the solid piece. 

As a general thing the tuberculous person is 
urged to eat voluminously, but it is not desirable 
that he should eat haphazardly; consequently 
his supervising physician will order such a schedule 
of diet as will fit in with the convenience of the 
patient, afford him full nourishment, and at the 
same time, give the adea x uate and necessary in- 
tervals of rest. 

These apparently trifling details, when intel- 
ligently regulated, combine into a marvelous 
power for good, so increasing the vital force of 
the system that the disease can make no progress, 
and will, therefore, eventually, all being well, be 
made to yield. Even if the patient does not have 
the benefit of the Tuberculozyne medical treat- 
ment, I still believe the hygienic treatment and 
general advice given in this book will be invalu- 
able to him. 

The tuberculous patient has duties towards 



Social Responsibilities 161 

those around him. For his own sake, as well as 
others, he should not expectorate into a hand- 
kerchief, for this results in the bacilli drying and 
shaking off into the lining of his pocket. Many 
a man who has neglected this simple precaution 
carries around in his pocket more than enough 
bacilli to infect all his friends, relatives and asso- 
ciates, not excepting reinfection of himself. 

Sputum, if not deposited in a cuspidor, which 
should always contain water, should be spat into 
a Japanese paper handkerchief or a piece of 
waste, which should then be put inside a paper 
bag before it is replaced in the pocket. At 
frequent intervals this waste or paper handker- 
chief should be destroyed by fire. Under no 
circumstances should a tuberculous person spit 
indiscriminately. By so doing he endangers 
every one around him; and do not forget this, 
himself also, for his own dried sputum, may float 
back into his own lungs and reinfect them in 
another place. 

Sun and air quickly destroy the bacilli. The 
consumptive should, however, never spit on the 
sidewalk, for the sputum may get upon the shoes 



162 Tuberculosis 

or clothing of passers-by, and in that way be 
carried into dwellings. 

It is the duty of every consumptive to see that 
his home is made properly antiseptic. If one 
knows how to go about destroying the germs 
that may have accumulated in the home of a 
tuberculous person, he can quickly make the house 
sanitary without any more than a temporary 
inconvenience to its occupants. If this is not 
done, however; if the patient's home is not made 
medically clean by proper instructions from a 
competent physician, it may continue a very 
hotbed and forcing house for the bacilli. Such a 
home is a deadly danger not only to every person 
who steps across its threshold, but also to those 
who occupy it, not excepting, remember, the 
tuberculous occupant himself. 

On request we will furnish without charge 
full instructions for the disinfection of the home. 

The medical treatment of tuberculosis is very 
important. If in the consumptive the functions 
of the body He supine under the debilitating in- 
fluence of the disease, they must be invigorated 
and revived with hygienic and dietetic measures. 



Service to Humanity 163 

Certain remedies are needed in certain cases to 
spur on digestion. The digestive organs, through 
neglect or ignorance, may become almost func- 
tionally inactive. This condition must be antag- 
onized by quick-acting, but wholesome medicines. 
There are occasions in which an essential secre- 
tion must be artificially supplied, at least, for 
the time being. 

The patient should have a good appetite, and 
there are medicines which do much toward in- 
creasing largely the desire for food and the cor- 
responding satisfaction in its consumption. 

We have no right to scatter germs about. We 
should be as careful to make sure they shall do 
no harm to others, as we would if the sputum 
were so much deadly poison, — which in fact it is. 

Consumptives should realize that on them 
individually depends the ultimate triumph of 
humanity over this terrible disease. It is the 
patient himself, individually and collectively, 
who must do the preventing, — and by perform- 
ing this duty faithfully he serves his fellow man 
and serves himself as well. 

The physician expert in the treatment of tuber- 



1 64 Tuberculosis 

culosis knows not only how to direct the daily- 
lives of well-to-do people, but, coming in contact 
as he does with people in all stations of life, he 
is equipped to give those who are not well off 
in this world's goods clever suggestions how they 
may at slight expense equip themselves with 
warm coverings, fresh air appliances, and cheap, 
but effective, means of correcting the sanitation 
of their homes. To such people the Tubercu- 
lozyne System of Treatment is doubly valuable. 
For example: almost any amount of money 
can be spent to provide the patient with open- 
air living and sleeping accommodations. The 
wealthy will spend hundreds of dollars, whereas 
the man in moderate circumstances must devise 
something costing a very small amount, or, 
better still, something he can make himself. 
The expert should, therefore, not only be com- 
petent as a physician, but also somewhat expert 
in tents and window carpentry. It often de- 
volves upon us to give instructions how windows 
and porches may be adapted to the patient's 
purposes. Many have no idea how to establish 
an outdoor or semi-outdoor sleeping apartment. 



Medicines Very Necessary 165 

To these we can give very helpful and practical 
suggestions, in most instances very easily carried 
out at slight expense. With a few practical hints 
they see how changes can be made that will 
create admirable sanatorium accommodations, 
which without this advice they would not have 
thought possible. 

When diarrhoea is present, medicines are ab- 
solutely demanded, and the proper choice of 
remedies will result in an immediate increase in 
the well-being of the patient. Diarrhoea is one 
of the greatest drawbacks possible to the steady 
progress of a case toward recovery. It may 
defeat every effort unless it can be overcome. 
Medicines and proper diet are our surest means 
of correcting this condition. 

The normal growth of nutrition may be a 
little too slow, and this is apt to be the case 
especially with those patients in whom it is essen- 
tial to develop the bodily strength at the earliest 
possible moment. We therefore need depend- 
able tissue-forming remedies, and possibly some 
that will prevent destruction of tissue. 

Where we have pain the proper remedy may 



1 66 Tub erculosis 

come as a balm and a blessing. This is especially- 
true in cases of throat tuberculosis. Under no 
circumstances, except those in which it is an 
unavoidable necessity, should nerve-numbing drugs 
be administered. Pain is often the cry of starved 
nerves, and the way to correct this condition 
and the pain thus caused is to increase the nutri- 
tion of the body. 

Cough is one of the distressing symptoms of 
tuberculosis, of which the average patient wishes 
to be speedily relieved. As stated elsewhere, 
cough is a safety valve, and it is the duty of the 
physician not to stop it, but only, if it be harsh 
and painful, to make it mild and painless. 

Landerer says "it is possible under certain 
circumstances, with certain remedies, to promote 
the growth of connective tissue about the tuber- 
culous abscess, so that the disease may be limited 
and conditions favorable to rapid healing pro- 
duced." 

It is also necessary in some cases to loosen 
the sputum or phlegm. Occasionally this phlegm 
is so tenacious that it racks the patient from crown 
to heel to relieve himself of even a trifling quantity 



Tuberculozyne System of Treatment 167 

of it. Such cases need attention at once, for 
these periodical strainings of the system exhaust 
the strength needed to combat the disease. 

The Tuberculozyne System of Treatment is 
designed to build up the constitutional force and 
to inspire the failing physical powers to new and 
successful efforts. If adopted early, before the 
disease has made serious inroads, its faithful 
use for some weeks should result in decided 
benefit. 

Already the Tuberculozyne System of Treat- 
ment has been administered to many hundreds of 
patients in every stage of lung disease. Many 
of these people, even when they feared their case 
was hopeless, determined to try this, and in 
these extreme cases, the results obtained have 
often been remarkable, not only in the health re- 
gained, but in the shortness of time consumed in 
bringing about these unexpected results. Natu- 
rally, the percentage of success is greater among 
those suffering from the earlier or minor stages 
of lung disease. It is these earlier, milder cases 
we would advise to take treatment at once, for 
if hopeless and helpless ones, sinking slowly and 



1 68 Tuberculosis 

silently toward the Great Unknown, found in the 
Tuberculozyne System of Treatment life and 
health, these less desperate sufferers are surely 
warranted in expecting equal benefits. 

That it is effective, which after all is the chief 
virtue of any form of treatment, is, I think, 
amply proven by the reports contained in the 
appendix. 

NOTE 

The appendix mentioned in this book is printed 
in separate form, and should be preserved for 
purposes of reference. 

If lost or mislaid, write for another copy, which 
will be mailed free of charge. 

The Yonkerman Company, 
Kalamazoo, Michigan, U. S. A. 



J 1911 



One copy del. to Cat. Div. 

dec i »sm 



